Why Physical Therapy and Occupational Therapy for Autism? Why Hippotherapy?


Parker receives both physical and occupational therapies as part of his public school developmental preschool education IEP.  He participates in a 30 minute “motor group” session one day a week with his school physical therapist. His occupational therapist visits his mainstream classroom for 30 minutes a week to help him with fine motor activities and engaging with peers in an appropriate manner.  Both of these therapies are very beneficial for Parker, and something that I’m very thankful he has an opportunity to receive through the public school system. But he needs more. And his young brain is plastic and still developing. So we’ve chosen to pursue private therapies in addition, in an effort to help Parker close the developmental gap between himself and same-age peers.

Parker has been going to TherAplay since August 2015. He initially started there with just physical therapy, but after seeing the tremendous benefits, we added occupational therapy in October 2016.

If you’re not familiar with the motor difficulties autistic children (and adults) can experience, you might be wondering, “Why does he need physical therapy? Why occupational therapy?” And more specifically, “Why hippotherapy?” Wait! What IS hippotherapy?!

According to the American Hippotherapy Association, “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 to engage sensory, neuromotor, and cognitive systems to achieve functional outcomes.”

Parker, like up to 90% of autistic children, struggles with postural instability.  His core is weak, and he has trouble coordinating the muscles needed to sustain prolonged, unsupported, upright posture. (Think sitting still in a chair, standing in line, or sitting on the floor for circle time.)This is evident in his propensity to lean and seek support when engaged in these static activities.

A 3 year old Parker leans while playing. (Children’s Museum of Indianapolis)

A horse averages 100-120 steps per minute at a working gait. In a 30 minute riding session, Parker can have up to  3,600 separate opportunities to respond to the dynamic movements of the horse’s body. During the session, Parker is seated forward, backward, sideways, on hands and knees, and standing on the horse’s back. The therapists use these varied positions to engage and strengthen particular muscle groups. An additional benefit of hippo therapy is the sensory input Parker receives. The vestibular and proprioceptive stimulation is very calming for him, and the effects last for several hours following therapy.  For each one-hour session of therapy (both physical and occupational), Parker will be on the horse for 30 minutes. The remainder of the session is spent working in the therapy clinic with his therapists.

Parker seated sideways on Fairytale for the equine portion of therapy with Miss Teresa.

For the clinic portion of Parker’s physical therapy, Parker has the unique opportunity to work with therapistTeresa Keathley and her specially trained dog (from Canine Companions for Independence).  A dog can engage a child in a way that is more playful and less like “work.” Parker can throw a ball, have races with the dog, and use the dog for support during activities requiring balance (balance beam, wobble disk, etc.). Parker struggles with motor planning, and is easily discouraged when asked to perform activities he perceives as “work.” When he’s playing with the dog, he works hard without the fear of failure.

Parker practices the balance beam under the watchful eye of Dorian, clinic therapy dog.


Unfortunately, Teresa’s first canine partner Dorian passed away late last year after a long battle with cancer. Everyone was pleasantly surprised when Teresa learned not long after that she would be getting another therapy dog from CCI. “AJ” had huge paws to fill, but his youthful exuberance has been a tremendous blessing. Parker loves getting to see AJ on Monday mornings.

Parker, Miss Teresa, and AJ at the TherAplay Winter party

Parker sees Miss Leah weekly for occupational therapy. I don’t remember the exact statistics on sensory dysintegration and autism, but I do remember reading once that not all people with sensory processing disorder are autistic, but all autistic people have sensory processing difficulties. Parker also struggles with hypotonia and finds fine motor tasks very difficult to complete due to lack of hand strength.

Many times, Parker will use his hands for fine motor tasks while riding the horse with Miss Leah. He thinks he’s helping his horse with a fancy new hair-do   by adorning his or her mane with hair clips, when he’s actually giving his hands and fingers an intense workout. She also helps him with mastery of tasks like putting on his clothing independently, tying shoes, snapping snaps, and zipping zippers.

Most recently, Miss Leah has been helping Parker with his sensory “diet.” A sensory diet is a regimen of specific activities to help Parker regulate his sensory needs and aversions. He tried a “sensory sock” with her recently, and will be getting one for home use. Be watching for a post on sensory strategies coming soon!

Some of you might be wondering about the cost of hippotherapy. Fortunately, most major insurance companies cover hippotherapy under physical and occupational therapies billing. This is the case for us. We pay the required copay and deductible portion as defined in our coverage. The medicaid waiver also covers these therapies. For patients without coverage, Children’s TherAplay Foundation offers scholarships, and is able to provide treatment to kids who need it with fundraising efforts and generous donations from the community.

In addition to the tremendous benefits hippotherapy has on postural stability/core strength and sensory regulation, it also benefits Parker to learn to develop close relationships with other trusted adults and animals. Prior to starting therapies at TherAplay, Parker didn’t have much interest in animals. As an animal lover, it’s heartwarming for me to see him developing bonds with them and appreciating the various ways animals can enrich our daily life.

And an added benefit for mom… I’ve met some life friends while sitting in the waiting room adjacent to the indoor arena. 🙂