BlueCross BlueShield of Tennessee Medical Policy Manual



Hippotherapy, also referred to as equine movement therapy, describes a treatment strategy that uses equine movement to engage sensory, neuromotor and cognitive systems to achieve functional outcomes. Hippotherapy has been proposed as a technique to decrease the energy requirements and improve walking in individuals with cerebral palsy. It is thought that the natural swaying motion of the horse induces a pelvic movement in the rider that simulates human ambulation. Also, variations in the horse’s movements can prompt natural equilibrium movements in the rider. Hippotherapy is also being evaluated in individuals with multiple sclerosis and other causes of gait disorders, such as strokes. Professional therapists compare hippotherapy to other therapy tools such as balls, scooters, and swings.




Evidence is lacking to determine if hippotherapy has a clinically significant treatment impact. No published studies are available addressing long-term efficacy.


BlueCross BlueShield Association. Evidence Positioning System. (4:2021). Hippotherapy (8.03.12). Retrieved June 11, 2021 from (22 articles and/or guidelines reviewed)

Bunketorp-Käll, L., Pekna, M., Pekny, M., Blomstrand, C., & Nilsson, M. (2019). Effects of horse-riding therapy and rhythm and music-based therapy on functional mobility in late phase after stroke. NeuroRehabilitation, 45 (4), 483-492. (Level 2 evidence)

Champagne, D. Corriveau, H. & Dugas, C. (2017).  Effect of hippotherapy on motor proficiency and function in children with cerebral palsy who walk. Physical & Occupational Therapy in Pediatrics. 37 (1), 51-63. Abstract retrieved April 17, 2017 from PubMed database.

Chinniah, H., Natarajan, M., Ramanathan, R., & Ambrose, J.W.F. Effects of horse riding simulator on sitting motor function in children with spastic cerebral palsy. Physiotherapy Research International, 25 (4), e1870.

Kwon, J., Chang, H., Yi, S., Lee, J., Shin, H., & Kim, Y. (2015). Effect of hippotherapy on gross motor function in children with cerebral palsy: a randomized controlled trial. Journal of Alternative & Complementary Medicine, 21 (1), 15-21. Abstract retrieved July 19, 2016 from PubMed database.

Lee, C., Kim, S., & Yong, M. (2014). Effects of hippotherapy on recovery of gait and balance ability in patients with stroke. Journal of Physical Therapy Science, 26, 309-311. (Level 3 evidence)

Lindroth, J., Sullivan, J., & Silkwood-Sherer, D. (2015). Does hippotherapy affect use of sensory information for balance in people with multiple sclerosis? Physiotherapy Theory and Practice, 31 (8), 575-581. Abstract retrieved July 20, 2016 from PubMed database.

Lucenta-Anton, D., Rosety-Rodriguez, I., & Moral-Munoz, J. (2018). Effects of a hippotherapy intervention on muscle spasticity in children with cerebral palsy: A randomized controlled trial. Complementary Therapies in Clinical Practice, 31, 188-192. Abstract retrieved November 5, 2020 from PubMed database.

Marquez, J., Weerasekara, I., & Chambers, L. (2020). Hippotherapy in adults with acquired brain injury: A systematic review. Physiotherapy Theory and Practice, 36 (7), 779-790. Abstract retrieved November 5, 2020 from PubMed database.

Rigby, B., & Grandjean, P. (2016). The efficacy of equine-assisted activities and therapies on improving physical function. Journal of Alternative & Complementary Medicine, 22 (1), 9-24. Abstract retrieved July 20, 2016 from PubMed database.

Rigby, B., Gloeckner, A., Sessums, S., Lanning, B., & Grandjean, P. (2017). Changes in cardiorespiratory responses and kinematics with hippotherapy in youth with and without cerebral palsy. Research Quarterly: Exercise & Sport, 88 (1), 26-35. Abstract retrieved April 17, 2017.

Srinivasan, S.M., Cavagnino, D.T, & Bhat, A.N. (2018). Effects of equine therapy on individuals with autism spectrum disorder: a systematic review. Review Journal of Autism and Developmental Disorders, 5 (2), 156-175. (Level 2 evidence)

Trzmiel, T., Purandare, B., Michalak, M., Zasadzka, E., & Pawlaczyk, M. (2019). Equine assisted activities and therapies in children with autism spectrum disorder: A systematic review and a meta-analysis. Complementary Therapies in Medicine, 42, 104-113. (Level 2 evidence)




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