THE ROLE OF HIPPOTHERAPY IN THE REHABILITATION OF PATIENTS WITH SELECTED CENTRAL NERVOUS SYSTEM DISORDERS: A NARRATIVE REVIEW
Abstract
Introduction: Hippotherapy is an equine-assisted intervention gaining popularity to support the rehabilitation of patients with neurological disorders. By applying the horse’s rhythmic movement, it aims to improve motor function, postural control, and overall quality of life. In addition to traditional therapy with live animals, mechanical simulators are now also employed. Neurological conditions such as cerebral palsy, stroke, and multiple sclerosis often lead to functional impairments that may benefit from complementary therapies.
Aim: The aim of this review is to evaluate the effectiveness of hippotherapy in improving physical and psychosocial outcomes in patients with selected central nervous system disorders.
Review methods: All data were collected from publicly available sources. This article's databases were accessed via PubMed, Google Scholar, and other scientific databases in May 2025.
Conclusions: Hippotherapy appears to be an effective complementary method in the rehabilitation of patients with neurological disorders, offering improvements in motor function, balance, posture, and psychosocial well-being. Both traditional and simulator-based forms show therapeutic potential. However, variability in study quality, small sample sizes, lack of standardization, and high costs limit the strength of current evidence. Further high-quality research is needed to confirm its effectiveness and cost-efficiency in clinical practice.
References
Rodríguez-Martínez MDC, Maestre AD la P, Armenta-Peinado JA, Barbancho MÁ, García-Casares N. Evidence of animal-assisted therapy in neurological diseases in adults: A systematic review. Vol. 18, International Journal of Environmental Research and Public Health. MDPI; 2021.
Mittly V, Farkas-Kirov C, Zana Á, Szabó K, Ónodi-Szabó V, Purebl G. The effect of animal-assisted interventions on the course of neurological diseases: a systematic review. Syst Rev. 2023 Dec 1;12(1).
Warutkar VB, Krishna Kovela R. Review of Sensory Integration Therapy for Children With Cerebral Palsy. Cureus. 2022 Oct 26;
Ramezani K, Kalantari M, Pashmdarfard M, Akbarzadeh Baghba A, Rahmanian S, Khavari G. Impacts of hippotherapy simulation on balance, postural control, and spasticity of thigh adductor muscles in children with spastic bilateral Cerebral Palsy: A single-blind clinical trial study. Iran J Child Neurol. 2025 Jan 1;19(1):79–96.
Obrero-Gaitán E, Montoro-Cárdenas D, Cortés-Pérez I, Osuna-Pérez MC. Effectiveness of Mechanical Horse-Riding Simulator-Based Interventions in Patients with Cerebral Palsy—A Systematic Review and Meta-Analysis. Vol. 9, Bioengineering. MDPI; 2022.
Potvin-Bélanger A, Freeman A, Vincent C. Hippotherapy and life habits with children with motor deficit and neurodevelopmental impairment: A pilot survey of parents. J Pediatr Rehabil Med. 2021;14(1):41–9.
Giermaziak W, Fryzowska-Chrobot I. Terapie z udziałem zwierząt w leczeniu i rehabilitacji chorych i niepełnosprawnych. Animal-assisted therapies in treatment and rehabilitation of diseased and disabled. Medycyna Rodzinna. 2018 Apr;21(1A).
White-Lewis S. Equine-assisted therapies using horses as healers: A concept analysis. Nurs Open. 2020 Jan 1;7(1):58–67.
Bravo Gonçalves Junior JR, Fernandes de Oliveira AG, Cardoso SA, Jacob KG, Boas Magalhães LV. Neuromuscular activation analysis of the trunk muscles during hippotherapy sessions. J Bodyw Mov Ther. 2020 Jul 1;24(3):235–41.
Giannou I, Katsina M, Dimitriadis Z, Paras G, Besios T. The effect of hippotherapy on people with multiple sclerosis, a systematic review. Mult Scler Relat Disord. 2025 May 1;97.
Franczyk-Sikorska E. Terapia z udziałem zwierząt (animal assisted therapy) jako komplementarna metoda terapii. Kwartalnik Pedagogiczny. ANIMAL ASSISTED THERAPY AS A COMPLEMENTARY METHOD OF THERAPY 2022 Dec 3;(68/2):125–36.
Rigby BR. Characterizing stress during animal interaction: a focus on the human endocrine response during equine-assisted services. Vol. 10, Frontiers in Veterinary Science. Frontiers Media SA; 2023.
Guindos-Sanchez L De, Lucena-Anton D, Moral-Munoz JA, Salazar A, Carmona-Barrientos I. The effectiveness of hippotherapy to recover gross motor function in children with cerebral palsy: A systematic review and meta-analysis. Vol. 7, Children. MDPI; 2020.
Paul S, Nahar A, Bhagawati M, Kunwar AJ. A Review on Recent Advances of Cerebral Palsy. Vol. 2022, Oxidative Medicine and Cellular Longevity. Hindawi Limited; 2022.
Matusiak-Wieczorek E, Dziankowska-Zaborszczyk E, Synder M, Borowski A. The influence of hippotherapy on the body posture in a sitting position among children with cerebral palsy. Int J Environ Res Public Health. 2020 Sep 2;17(18):1–9.
Selph SS, Skelly AC, Wasson N, Dettori JR, Brodt ED, Ensrud E, et al. Physical Activity and the Health of Wheelchair Users: A Systematic Review in Multiple Sclerosis, Cerebral Palsy, and Spinal Cord Injury. Vol. 102, Archives of Physical Medicine and Rehabilitation. W.B. Saunders; 2021. p. 2464-2481.e33.
Menor‐rodríguez MJ, Martín MS, Sánchez‐garcía JC, Montiel‐troya M, Cortés‐martín J, Rodríguez‐blanque R. Role and effects of hippotherapy in the treatment of children with cerebral palsy: A systematic review of the literature. Vol. 10, Journal of Clinical Medicine. MDPI; 2021.
Plotas P, Papadopoulos A, Apostolelli EM, Vlachou E, Gazou F, Zogopoulou I, et al. Effects of hippotherapy on motor function of children with cerebral palsy: a systematic review study. Vol. 50, Italian Journal of Pediatrics. BioMed Central Ltd; 2024.
Viruega H, Gaillard I, Briatte L, Gaviria M. Inter-day reliability and changes of surface electromyography on two postural muscles throughout 12 weeks of hippotherapy on patients with cerebral palsy: A pilot study. Brain Sci. 2020 May 1;10(5).
Faccioli S, Pagliano E, Ferrari A, Maghini C, Siani MF, Sgherri G, et al. Evidence-based management and motor rehabilitation of cerebral palsy children and adolescents: a systematic review. Vol. 14, Frontiers in Neurology. Frontiers Media S.A.; 2023.
Hyun C, Kim K, Lee S, Ko N, Lee IS, Koh SE. The Short-term Effects of Hippotherapy and Therapeutic Horseback Riding on Spasticity in Children with Cerebral Palsy: A Meta-analysis. Vol. 34, Pediatric Physical Therapy. Lippincott Williams and Wilkins; 2022. p. 172–8.
Ortega-Cruz A, Sánchez-Silverio V, Riquelme-Aguado V, Alonso-Perez JL, Abuín-Porras V, Villafañe JH. Effects of Hippotherapy and Horse-Riding Simulators on Gross Motor Function in Children with Cerebral Palsy: A Systematic Review. Vol. 14, Journal of Clinical Medicine. Multidisciplinary Digital Publishing Institute (MDPI); 2025.
Physical therapy with hippotherapy compared to physical therapy alone in children with cerebral palsy: Systematic review and meta-analysis. Dev Med Child Neurol. 2023 Mar 1;65(3):e25.
Kuriakose D, Xiao Z. Pathophysiology and treatment of stroke: Present status and future perspectives. Vol. 21, International Journal of Molecular Sciences. MDPI AG; 2020. p. 1–24.
Feigin VL, Brainin M, Norrving B, Martins SO, Pandian J, Lindsay P, et al. World Stroke Organization: Global Stroke Fact Sheet 2025. International Journal of Stroke [Internet]. 2025 Feb 3;20(2):132–44. Available from: https://journals.sagepub.com/doi/10.1177/17474930241308142
Bunketorp-Käll L, Pekna M, Pekny M, Blomstrand C, Nilsson M. Effects of horse-riding therapy and rhythm and music-based therapy on functional mobility in late phase after stroke. NeuroRehabilitation. 2019;45(4).
ÖZTÜRK S, AYDOĞDU O, SARI Z. Efficacy of hippotherapy simulator exercise program in patients with stroke: a randomized single-blind clinical trial. Top Stroke Rehabil. 2024;31(6).
Çoban O, Mutluay F. The effects of mechanical hippotherapy riding on postural control, balance, and quality of life (QoL) in patients with stroke. Disabil Rehabil. 2024;46(11).
Bunketorp-Käll L, Pekna M, Pekny M, Samuelsson H, Blomstrand C, Nilsson M. Motor Function in the Late Phase After Stroke: Stroke Survivors’ Perspective. Annals of Rehabilitation Medicine . 2020;44(5):362–9.
Marquez J, Weerasekara I, Chambers L. Hippotherapy in adults with acquired brain injury: A systematic review. Vol. 36, Physiotherapy Theory and Practice. 2020.
Duan H, Jing Y, Li Y, Lian Y, Li J, Li Z. Rehabilitation treatment of multiple sclerosis. Vol. 14, Frontiers in Immunology. Frontiers Media S.A.; 2023.
Jankowska A, Chwojnicki K, Szurowska E. The diagnosis of multiple sclerosis: what has changed in diagnostic criteria? Vol. 88, Polish Journal of Radiology. Termedia Publishing House Ltd.; 2023. p. e574–81.
Moraes AG, Neri SGR, Motl RW, Tauil CB, von Glehn F, Corrêa ÉC, et al. Effects of hippotherapy on postural balance, functional mobility, self-perceived fatigue, and quality of life in people with relapsing-remitting multiple sclerosis: Secondary results of an exploratory clinical trial. Mult Scler Relat Disord. 2021 Jul 1;52.
Kabuk A, Şevgin Ö. Comparison of the effects of mechanical hippotherapy and Cawthorne-Cooksey exercises in patients with multiple sclerosis: Randomized trial. Mult Scler Relat Disord. 2024 Jul 1;87:105697.
Salbaş E, Karahan AY. Effects of hippotherapy simulation exercise vs. conventional home exercises on muscle strength and balance in people with multiple sclerosis: A randomized controlled trial. Mult Scler Relat Disord. 2022 Dec 1;68:104111.
Makowska I, Pierchała K, Niemczyk K. Rehabilitacja przedsionkowa w zawrotach głowy i zaburzeniach równowagi. Polski Przegląd Otorynolaryngologiczny. Vestibular and balance rehabilitation therapy 2014 Jan;3(1):20–6.
Suárez-Iglesias D, Bidaurrazaga-Letona I, Sanchez-Lastra MA, Gil SM, Ayán C. Effectiveness of equine-assisted therapies for improving health outcomes in people with multiple sclerosis: A systematic review and meta-analysis. Vol. 55, Multiple Sclerosis and Related Disorders. Elsevier B.V.; 2021.
Moraes AG, Neri SGR, Motl RW, Tauil CB, Glehn F von, Corrêa ÉC, et al. Effect of hippotherapy on walking performance and gait parameters in people with multiple sclerosis. Mult Scler Relat Disord. 2020 Aug 1;43.
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