Hippotherapy—Just Horsin' Around?

Guest post by Alyson who blogs at wordsofhisheart. (Make sure you check out her blog. She has a wealth of great speech resources there.)

The first time I heard about hippotherapy, I didn't take it very seriously. I envisioned children who should have been in physical therapy instead donning cowboy hats and going for a leisurely trail ride.

But when Noah turned 5 and still wasn't speaking, I remembered posts I had seen on our local Down syndrome network from parents singing the praises of hippotherapy. After doing online research and watching some amazing YouTube videos of children participating in speech, occupational, and physical therapy while riding, it became clear that these therapies were successfully coordinated into the hippotherapy session, mimicking real life experiences.

Seeing the integration peaked my interest because Noah was having a difficult time processing the information necessary for speech along with all the other skills he was acquiring. When his speech therapist confirmed a diagnosis of apraxia, I knew it was time to pursue hippotherapy.

Was it grasping at straws? Maybe. But the amazing results we’ve seen in the four weeks Noah has been participating in hippotherapy have convinced me of its value as a legitimate therapeutic modality.



The Four Week Scoop
Week 1: An adult rode on the horse with Noah. They spent a few minutes in the arena walking and then throwing balls into a basketball hoop where Noah worked on color identification. Next they rode outside on the trail where the trees were full of hanging animals—a perfect opportunity to work on vocabulary and signing. I was worried that he would be terrified; he wasn't.

Week 2: Noah rode the horse by himself. His therapist and the arena volunteers walked along either side of the horse. During this session Noah's posture had improved. Instead of the common low tone slouch, Noah was sitting straight and tall. This was an instinctual posture correction that was necessary to feel the most secure on the horse. No prompting was necessary.

Week 3: Noah couldn't get on that horse fast enough. When his time on horseback ended, Noah’s PT had him do some running, throwing, and climbing using onsite equipment.

Week 4. Noah rode that horse backward! The PT actually had him sit facing the horse's tail for part of the session. He rode in from the trail in that position, and it was evident by his posture and expression that his confidence level was very high. After the ride, he continued his running, throwing, and climbing.

The Results
The biggest change for Noah has been the area of speech. Prior to hippotherapy, he could say only a few words clearly and would attempt speech only if it was modeled for him. After only four sessions, Noah speaks about 20 words clearly and is making approximations of several more, sometimes spontaneously. Something extraordinary happens to Noah when he is up on that horse and it carries over to his daily living. The feeling of the rhythm of the horse walking seems to be helping Noah’s brain organize what it needs to make speech happen.

Hippotherapy Vs. Horseback Riding
There is a notable difference between hippotherapy and horseback riding. In hippotherapy, the horse is used as the treatment tool to achieve physical, speech, and occupational therapy goals. In horseback riding, the rider's focus is to improve on their horsemanship skills, and in the process develop companionship, responsibility, confidence, and leadership skills.

Getting Started
So, you're interested in hippotherapy for your child... now what? If your child is at least 2 years old and currently receiving early intervention services, ask his or her therapists if they offer board-certified hippotherapy or if they know of a local therapist that does. I was not even aware Noah's center offered it until I asked. You can also visit the American Hippotherapy Association to find a therapist in your area. Remember, this is not just a physical therapy option; speech and occupational therapists can also be board certified to conduct hippotherapy sessions as well.

And now for the question everyone wants answered: Will insurance pay for it? Under some policies, yes insurance will pay for it. When submitting therapy claims, the insurance company is not usually interested in what equipment is used in therapy; they just want to know who provided the service and that the therapy did take place. Unless a policy specifically excludes equine-assisted (horse) therapy, they will likely cover it. Unfortunately, Medicaid is an insurer who specifically excludes hippotherapy. The good news is that many of the hippotherapy centers offer scholarships, so don't hesitate to ask if you need one.

Happy Trails!

Your Turn
I was so excited after reading Alyson’s post that I went straight to the AHA and located a few therapists in our area. We are going to pursue hippotherapy! How about you? Has your child participated in hippotherapy? If so, were you impressed with the results? If your child hasn’t done it yet, are you interested in checking out hippotherapy?

Which Walker is Best?

Just because they named it a walker doesn’t mean it will help facilitate independent walking for your child. There are no studies that support the idea that putting your child with Down syndrome in a walker will help him to reach that milestone sooner. In fact there is some evidence that shows that children who use walkers actually learn to walk on their own later than their peers.

Pros & Cons of Walkers
Like any baby contraption that has a seat and some toys attached, a walker can be useful when you need to put your child in a safe, entertaining place while you answer the phone or cook dinner.

If your child is not ready for a walker, there are risks involved with putting him in one. A walker allows your child to bear weight on his joints that he may not be ready for if he does not have the core strength and stability to handle it. These abnormal forces on the joints can cause damage and can also teach your child patterns of posture and movement that are not typical for his development. Most walkers interfere with the child’s ability to see his legs and feet and therefore hinder his ability to receive important motor information about how his body works.

Having your child in a walker for long periods of time can also hamper sensory motor development because it controls what the child can “go for” and puts a barrier between the child and the world around him.

When a Child Can Benefit from a Walker
If your child has the desire to be up and moving around and can walk along the couch or coffee table, or can walk while holding on to a push toy, or can walk while you are holding his hands, yet cannot walk independently due to trouble with balance, susceptibility to fatigue, or some other underlying cause for delay, he might benefit from a therapeutic posterior walker.

A posterior walker provides the support and mobility a child needs to be able to walk around, yet does not inhibit proper gross motor and sensory development. A posterior walker should be introduced to your child by a trained physical therapist and his time using it must be closely monitored by a caregiver or therapist.

Ok, So...
Now that you may have changed your mind about buying a commercial walker, you might want to throw the big question out there, “When should my baby walk?” There is a very large age range for this skill and many factors determine when it comes. Some children with Ds start walking as early as 14 months, others are over the age of 4 before they master it. So unless a doctor or therapist has indicated that there may be a secondary cause for delayed walking, be patient... it will come. And, for those times you need to confine your child for his safety (or your sanity), stick with an exersaucer or playpen.

Eat Your Choline

Are your pregnant with a baby who has Down syndrome, or nursing a newborn? A recent study performed by Cornell University has shown that more choline given to developing babies with Down syndrome has lasting cognitive and emotional benefits.

Where can you get choline? There is a lot of it in eggs, beef, cauliflower, navy beans, tofu, almonds, peanut butter, and in Nutrivene-D. The recommended daily dose of choline for infants is about 150 mg a day. For pregnant moms it is 450 mg and for lactating moms it is 550 mg.

I am not sure how many eggs or how much beef liver you would have to eat to pass that much choline to your baby through breast milk, so you may want to ask your pediatrician if Nurtivene-D is right for your child.

To get you started eating your choline, here are two recipes:
For baby...
Vegi Puree (32.3 mg total choline)
1 oz. breast milk (4.5 mg choline) or milk (4.0 mg choline)
1oz cooked navy beans, mashed (8.6 mg choline)
1oz cooked cauliflower, mashed (10.9 mg choline)
1oz cooked carrots, mashed (2.5 mg choline)
1oz cooked sweet potato, mashed (3.7 mg choline)
1tbsp melted butter (2.6 mg choline)
Put in all in the food processor or blender and puree it until you reach the consistency your baby likes.

For you... (and baby, lol)
Nigerian Baked Beans whose leftovers become Summer Stew (284 mg total choline)
(from Madhur Jaffrey's World Vegetarian (modified by L.L.Barkat)


(ds.mama substituted navy beans for Great Northern beans and shortened the cooking time.)
Stir briefly over low heat..
1 onion, chopped and already sauteed until light brown (5.7 mg choline)
4 cloves garlic, minced (2.8 mg choline)
1 TB curry powder
Add onion and garlic mixture to...
1 1/2 cups dried Navy Beans, already soaked and cooked until tender (retain cooking water) (144 mg choline)
2 tomatoes, chopped (16.4 mg choline)
1 1/2 TB peanut butter (15 mg choline)
salt and pepper to taste
Bake all together about 45 minutes or until tender and sauce is thickened.

For Stew the Following Evening... ( adds about 100 mg choline)
• cut 4-5 potatoes (22 mg choline per potato) into 1/2 to 3/4 inch chunks, add to beans with enough water to cover, and cook 15 minutes or until tender
• garnish with one onion sliced very thin, browned until crisp
• add a generous scoop of herbed butter (5.2 mg choline) and stir until melted

Picture credit: L.L. Barkat.

EI—Who, What, When, and Why

The purpose of Early Intervention (EI) is to teach us how to give our little ones the extra support they may need to develop effective motor planning and skills.



EI starts off with the assignment of an EI service coordinator and an initial evaluation to figure out what therapeutical services will be beneficial for your child. During the evaluation you will be asked what things are important to you and your family concerning your child. Based on this evaluation and your input, a team of therapists is pulled together to help you and your child reach the goals you have set out.

The goals are written up for a six month period in a document called an Individualized Family Service Plan (IFSP). The IFSP is a living document that gets updated every six months (and sometimes sooner depending on any special circumstances) to reflect your families on-going needs and goals.



It is important to know three things about EI therapists... first of all, they work for you and your child, and you get to decide if the relationship is working out. If you are uncomfortable with a therapist for any reason at all, you can ask your EI service coordinator to switch the provider. Second, not all EI therapists have experience working with children with Down syndrome. And third, there are several concentrations within specific therapy fields. For example, some occupational therapists may have a strong background in sensory, while others may have more experience with self-care skills such as feeding and dressing.

When you are determining who will be working with your child, you should make sure the provider has experience with children with Down syndrome, and a level of expertise in the areas that are specific to your goals. In other words, not any old therapist will do.



Almost all infants with Down syndrome can benefit from working with a physical therapist (PT) and a speech and language pathologist (SLP) with a background in newborn feeding and oral motor skill development. Some infants may benefit from spending time with an occupational therapist (OT) who can provide a sensory program that includes deep pressure and brushing. Between 8 to 10 months of age, you probably should start pushing for a special instruction teacher. This educator will use play therapy to begin teaching your baby sign language, concepts such as in/out and up/down, as well as choice-making and other cognitive skills.

When EI is working right, you will find that you have a team of encouraging therapists who are:
—showing you at a detailed level all of the amazing developments your baby is achieving.
—training your child’s neurological pathways in effective motor activity and motor planning.
—teaching you how you can incorporate basic skill development into your baby’s everyday routines.
—teaching you how to provide your child with motor training, and sensory and cognitive experiences and that will help him develop constructive life skills.



EI is not about pushing your baby to the next big milestone, it is not about comparing your child to others, and it is not about making you feel inadequate as a parent. If you are experiencing those things, it may be time to consider some changes to your child’s team.

Your Turn
When did you start EI and what services did you start off with? What have been the pros and cons of EI for your family?