Hippotherapy (our signature treatment technique) and therapeutic/adaptive riding (which we do not do) are extremely different, yet both have their place. So, what exactly are you looking for?
Hippotherapy vs. Therapeutic/Adaptive Riding
- Hippotherapy is a one-on-one medical treatment because it is integrated into physical, occupational, or speech therapy. It concentrates on a certain set of patient outcomes. A doctor’s prescription is required, and therapy is often covered by health insurance, depending on your insurance policies.
- Therapeutic/adaptive riding is a recreational activity that has been modified to meet the requirements of people with disabilities. It usually takes place in semi-private or group sessions, with the main objectives being to improve riding abilities, establish confidence and relationships, and improve emotional well-being.
If you’re looking for a therapeutic or adaptive riding instructor or facility, you’ve come to the right place. Those who are members of the Professional Association of Therapeutic Horsemanship (PATH) International are recommended.
Can you bill for equine therapy?
HCPCS #S8940 (Equestrian/Hippotherapy, per session), CPT #97139 (Unlisted therapeutic procedure), or just normal CPT#90847 were recommended as possible procedure codes in policy (Family Psychotherapy, with patient present, 50 mins).
How much does equine therapy cost the patient?
Due to the advancement of Friedreich’s ataxia, I thought my horseback riding days were ended until I discovered Therapeutic Riding of Tucson (TROT) in Arizona.
I’m nearing the end of my second 12-week session at TROT, and despite having a neuromuscular condition at the age of 33, I’ve observed that therapeutic riding has provided me with numerous benefits.
Although majority of the TROT riders are children with cognitive problems, I’d like to raise awareness of the physical and emotional benefits of therapeutic riding and hippotherapy among individuals with neuromuscular disorders.
Therapeutic riding vs. hippotherapy
Many people confuse therapeutic riding and hippotherapy, although there are significant differences between the two.
Therapeutic riding’s main purpose is to teach people with impairments how to ride a horse. Most riders improve their riding skills and become more independent as they continue to ride.
Hippotherapy is a type of therapeutic riding that is always done by a registered physical or occupational therapist (PT or OT).
According to Susan March, program manager and physical therapist at Bit-By-Bit Therapeutic Riding Center in Parkland, Fla., hippotherapy is a therapeutic technique that employs the horse as a tool to focus on specific goals such as increasing balance, coordination, head control, and fine motor skills.
“Some people require the expertise of a therapist because their bodies are incapable of simply taking a standard riding lesson,” explains Sharon Gilbert, office manager for the American Hippotherapy Association (AHA) in Fort Collins, Colorado. The therapist’s purpose is to assist clients in transitioning from hippotherapy to regular therapeutic riding lessons.
A therapeutic riding center and its instructors should be certified by the Professional Association of Therapeutic Horsemanship International, or PATH Intl., to assure the highest standards and the safety of the riders (formerly the North American Riding for the Handicapped Association).
It’s critical to work with an OT or PT who is professionally trained in hippotherapy and registered with the AHA if hippotherapy is being used. Furthermore, therapists must be certified by PATH International or be accompanied by a certified staff member. Some therapists go above and above to earn the title of hippotherapy clinical specialist, a title that denotes a high level of expertise in the field.
Therapeutic riding sessions can be done quietly or in groups, although Gilbert emphasizes that hippotherapy sessions are always private.
Therapeutic riding and hippotherapy are both done in an arena, on the grounds of the center, or on the trails. Riders with higher experience can also weave through barrels or cones, or step over ground poles, in both events.
A individual therapeutic riding session costs $40-$75, while a group session costs $30-$75. Scholarships, both full and partial, are frequently available; inquire at the riding facility for additional information.
Hippotherapy sessions cost roughly $80-$115 per session, however some health insurance companies will cover it in full or in part. Medicaid will cover the cost of hippotherapy in some states, such as Florida. Scholarships may be available as well.
Before the ride
The first step is to have a physician fill out a medical release form before beginning therapeutic riding. Riders must next be assessed by a therapeutic riding instructor, who will assess their strength, balance, and ability to sit on a horse.
Instructors must decide how much help riders will require while riding and how much they can perform on their own. After that, there will be a test ride for further evaluation.
Some states and insurance companies demand a physician’s prescription before beginning hippotherapy. Even if a prescription isn’t necessary, the doctor must nonetheless fill out a medical release form.
March, who is registered with AHA and has worked at Bit-By-Bit Therapeutic Riding Center for 10 years, explains that hippotherapy necessitates a more in-depth evaluation in which therapists examine each individual’s strengths and weaknesses and build a personalized treatment plan. Therapists create workouts based on this information, she explains.
Special horses, saddles and reins
The horses used in therapeutic riding and hippotherapy have been carefully chosen for this type of activity.
“Mary Vardi, a PATH Intl.-certified therapeutic riding instructor with TROT who has been active in therapeutic riding for more than 20 years, says, “I’m usually looking for a horse that has a very peaceful nature sound and not spooky.”
“He must be able to move well, with a good walk and trot, and he must be responsive but not too responsive.” Vardi normally selects horses for the program between the ages of 8 and 15.
Therapeutic riding teachers pair horses with people based on the horse’s size and width, temperament, and walking and trotting speed.
The style of saddle used is determined by how much support riders require. A western saddle, for example, provides greater support than an English saddle, which demands the rider to exert more control and balance.
According to Cheryl West, program manager and PATH Intl.-certified head teacher for the American Therapeutic Riding Center in Sand Springs, Okla., “a range of modified saddles are available at various therapeutic riding centers for people who need even more support.”
Adapted saddles may include front handle bars or high backs to accommodate riders with severe trunk control challenges, according to West.
Surcingles, which are leather or nylon harnesses that go from the rider’s front to the horse’s rib cage, are sometimes used by riders. Surcingles usually have one or two handles on top and are supported by a western saddle pad.
To offer the rider more movement during hippotherapy, therapists typically employ a surcingle and a western pad.
A selection of reins is also available at some therapeutic riding centers. Because riders can slip their fingers through the loops, looped reins can sometimes assist riders who have difficulties grasping the reins.
When the horse is ready, it is escorted to the mounting ramp, where the rider awaits. The rider is hoisted onto the saddle or surcingle by an overhead lift, where he or she is centered and the stirrups are adjusted.
Sessions may include a small group of participants, depending on the disability and the amount of support required: the rider, the specially chosen horse, the therapeutic riding instructor or therapist, the horse leader, and two side walkers, who are usually volunteers who walk alongside the horse offering support to the rider.
Emotional benefits
Therapeutic horseback riding and hippotherapy are both enjoyable ways to spend time outside. Therapeutic riding can be a very social activity because it can be done in group sessions.
Mastering the skills required to control the horse can boost self-esteem and provide a sense of empowerment for therapeutic riders. Therapeutic riders and hippotherapy customers may build confidence as they watch their progress over time.
“Camille Levy of Tampa, Fla., who has myotonic muscular dystrophy and uses both a power and manual wheelchair, says, “I’m able to feel more comfortable on the horse and not so worried that I’m going to fall off.”
For the past three months, Levy, 49, has been riding with Bakas Equestrian Center in Tampa. “It’s assisting me in learning to turn the horse around the poles, which I previously couldn’t do. It makes me happy, and that’s all that matters to me.”
Levy says she’s excited to compete in the Special Olympics equestrian competitions and win ribbons for barrel racing.
Trey Lovell, 23, of Perryville, Ark., values hippotherapy so much that he has driven three hours once a week to Beyond Boundaries in Ward, Ark., for the past three years. Lovell, who has Duchenne muscular dystrophy and uses a power wheelchair, says spending time with his horse, Comanche, is something he looks forward to.
Physical benefits
Therapeutic riding and hippotherapy provide several physical benefits, with some of these benefits occurring even while the horse is not moving. According to West, who has been instructing with the American Therapeutic Riding Center for five years, simply sitting on the horse stretches the adductor muscles of the thighs. Riders with tight muscles are occasionally started on a narrow horse and eventually progressed to bigger and wider horses.
The majority of the physical benefits, however, are due to the horse’s mobility.
“The horse often does the majority of the labor,” West explains. “The majority of the muscles in the rider’s body will be worked simply by the horse’s movements, including key muscle groups in the legs, arms, buttocks, torso, and neck.”
Riders are taught to maintain an erect stance against the horse’s movement, stretching their stomach and back muscles in the process. The rider’s muscles are required to contract in order to rebalance since the horse’s motions constantly put the rider off balance, she claims.
Many riders gradually require less trunk support from side walkers, and some become more self-sufficient while riding.
“I’ve seen kids who ride without side walkers, who have been doing it for a long time and are doing pretty well, and I know that I’ll get there, too,” says Levy, who has improved her balance in just three months of riding.
Levy initially sustained herself by “hanging on for dear life” with the saddle horn. She can now hold the reins in one hand while resting the other in her lap.
Trey Lovell’s OT at Beyond Boundaries, Alicia Hammerle, says she tests her clients’ balance by changing the horse’s direction or the rider’s position on the horse. The rider’s balance is shifted to one side to the other, forcing them to employ their trunk muscles to sit up straight.
“That can help strengthen their trunk control so that they can balance better for functional activities like reaching for a glass on the table or sitting up straight while brushing their teeth when they’re not on the horse,” adds Hammerle, who is registered with the AHA and certified by PATH Intl.
Lovell weaves Comanche through cones and does figure-8s in the arena as part of his balance exercises. He also focuses on his dexterity by practicing grasping the reins.
“With Trey, I’ve observed a huge improvement,” Hammerle says. “He was able to sit up on his own for a brief time on his bed not long after riding with us, which he couldn’t do before he started riding.”
Her suggestion to those who have been doing hippotherapy but are no longer able to do so for various reasons is to continue working with a therapist in a clinical context to progress any functional gains they may have achieved.
Finding a facility
Alternatively, call the American Hippotheray Association at (877) 851-4592 or go online to “Hippotherapy” and select “Find a Therapist” or “Find a Facility.”
Happy trails
TROT has been a great experience for me, and I plan to ride for as long as possible. Therapeutic riding not only brings back fond memories of my father and me horseback riding together, but it also helps me gain strength both on and off the horse.
More Fun with Horses: Therapeutic Carriage Driving
For people who desire (or need) to manage the horse while sitting in their wheelchair or on the carriage seat, driving a horse-drawn wheelchair-accessible cart or carriage is a popular pastime. The goal for therapeutic driving students is to learn to use the reins and their voice to drive the horse and carriage.
“It’s a two-dimensional movement versus the three-dimensional experience of riding,” Bonnie MacCurdy of the National Center for Equine Facilitated Therapy in Woodside, Calif., adds. “While learning a new and fascinating skill, a person can work on goals of flexibility, strength, posture, and range of motion.”
In order for driving pupils to use the reins, they must sometimes be modified. Therapeutic riding centers sell rein adaptations, but some driving instructors, like MacCurdy, prefer to construct their own.
For example, MacCurdy created a bar to link the reins for steering with one hand for drivers who can only use one hand. She’s also made loops in the reins to make it simpler for driving trainees with a weak grasp to hold the reins.
According to MacCurdy, who is seeking her therapeutic riding and driving certification with PATH Intl., carriage driving instructors also have a set of reins and can assist students as much or as little as they require. A driving session normally involves three to five volunteers.
Therapeutic driving is offered by a small number of PATH International-affiliated therapeutic riding centers. They can be found on the PATH International website (under “Find a Center,” select “Driving”) or by calling PATH International at (800) 369-7433.
The cost of therapeutic driving sessions is normally around $50 per session, although scholarships may be available; inquire at the riding center for more information.
Does Medicare cover equine therapy?
For a member who has received approval from their health care physician, hippotherapy or equine therapy is a covered benefit. Takes part in a case management or disease management program. Has a drug abuse disorder diagnosis.
How is equine therapy funded?
The RDA centers are funded in a variety of ways: some are self-funded, while others seek lottery and community grant financing from charities. Fundraising is also important for paying for necessary equipment such as riding helmets and keeping session expenses reasonable.
What is equine therapy used for?
Equine therapy, also known as Equine-Assisted Therapy (EAT), is a treatment that uses equine activities and/or an equine environment to help people with ADD, Anxiety, Autism, Cerebral Palsy, Dementia, Depression, Developmental Delay, Genetic Syndromes (such as Down Syndrome), traumatic brain injuries, behavioral issues, abuse issues, and a variety of other mental health issues. Equine Therapy can aid in the development of confidence, self-efficacy, communication, trust, perspective, social skills, impulse control, and the learning of boundaries in individuals. Because horses and people have comparable traits, such as social and responsive behaviors, it is simple for patients to form a bond with the horse. Riders with impairments compete in national and international sport riding championships, demonstrating their outstanding achievements. Most major countries have acknowledged equine-assisted therapies in the medical and mental health fields.
Equine therapy dates back to ancient Greek literature, when horses were utilized for therapeutic riding. In 600 B.C., Orbasis of ancient Lydia noted the therapeutic value of horseback riding. Following a poliomyelitis outbreak in Scandinavia in 1946, Equine Therapy was begun.
Therapeutic Riding was first introduced to the United States and Canada in 1960, when the Community Association of Disabled Riding was founded (CARD). Riding for the disabled evolved in the United States as a form of recreation and motivation for education, as well as therapeutic benefits.
Elephants, dolphins, dogs, and cats have all been utilized for therapeutic purposes in the past. Because horses provide quick reaction to the handler or rider’s activities, they have become the most popular animal to utilize in animal therapy. Horses are also capable of mirroring the feelings of their handlers or riders. The enormous and scary look of horses forces people to establish trust in them.
Application:
Equine therapy can entail more than just horseback riding. A client may not even touch the horse during some sessions. Often, the therapist in charge of the session would assign tasks to the client, such as bringing the horse to a specific location or putting a halter on the horse. The client will accomplish the assignment to the best of their abilities before discussing the thought process, concepts, and problem-solving techniques utilized to do it. When you talk about what the client is doing at any given time, you can help them develop their language abilities. Listening to the instructor improves a person’s capacity to follow directions, ask questions, and so on. Not just between the handler and the instructor, but also between the handler and the horse, there is communication. This ability is especially beneficial for people who suffer from anxiety since they are frequently engaged in worry about the past or catastrophic thinking about the future. This practice encourages people to be present and focused on what they’re doing.
Cognitive Therapy, as well as play and talk therapy, can be simply adapted by therapists who teach Equine-Assisted Therapies. The Equine therapist can make decisions about the procedures or tactics used in the sessions based on the nature of the anxiety and its degree. Cognitive therapy, practicing activities, activity scheduling, play therapy, story telling, and talk therapy are the main strategies used.
Cognitive Therapy is a sort of therapy that is frequently used to manage anxiety. Horses detect danger and respond by becoming more alert of their surroundings, often attempting to run if the situation appears to be too dangerous. Individuals with anxiety disorders may be able to detect these changes through observation, allowing them to talk to their therapist about their worrisome actions. The individual’s apprehensive response can be considerably reduced by focusing on the animal’s anxiety rather than on themselves, allowing them to fight automatic thinking. The patient would practice being calm and taking control of his or her own thoughts throughout this procedure.
Practicing activities: People who suffer from acute anxiety often avoid things that are difficult, frightening, or outside of their comfort zone. This method permits a person to choose an activity that is outside of their current ability level. The therapist will next provide assistance as needed and discuss with them about any thoughts or feelings that these exercises have triggered. Longing, washing, and feeding the horse, for example, all require coordination, planning, and active communication.
Because of the influence worry has on their lives, many persons suffering from anxiety will begin to avoid housework or other responsibilities that were previously a part of their regular routine.
However, the more they avoid, the more their anxiety is exacerbated by the prospect of returning to those activities.
Because the physical needs of the animal/horses can alter at any time, planning or setting a routine to care for an animal or horse throughout the day can give an individual a sense of responsibility as well as flexibility.
This helps the person to shift their focus away from their fear and return to the framework of the day, which fosters a sense of competence and responsibility.
Individuals can identify several horse qualities, such as play instincts, curiosity, independence, and social drive, through play therapy and story telling. Play therapy encourages and facilitates the formation of relationships and the establishment of boundaries. Story telling stimulates the development of stories about the animal’s thoughts and emotions. This is a fantastic tool for boosting language growth and inventiveness.
Because horses exhibit interpersonal behavior, equine therapy is frequently employed as a team-building exercise or in family or group therapy. Equine therapy also helps the group to work together to attain a common goal because it is generally goal driven.
The Unique Roles of Horses in EAT
Horses are nonjudgmental and neutral, reacting only to the patient’s conduct and feelings and not to the patient’s physical appearance or previous mistakes. This, according to patients, is critical to the therapy and supports in the development of self-esteem and self-confidence.
Feedback and mirroring: Their prey and herd animal nature causes them to be super attentive and sensitive, making them keen observers. This means they get feedback faster and more consistently than they would with a human therapist. The horse has an intrinsic inclination to replicate the patient’s behavior, bodily movements, and emotions, assisting the participant in becoming more self-aware. It gives sufferers the opportunity to “Feel it.” The horse specialist can then translate the feedback and the group can analyze it.
Metaphor for real life: The capacity of a therapist to utilize the horse as a metaphor for other concerns helps make the equine treatment adaptable to real life problems.
An example of how a therapist might use the horse as a metaphor to assist a patient work out issues in their own life: “One of the kids was having a hard time expressing their feelings about a pending move to another state. She was, nevertheless, able to provide numerous tips for making a horse that was being sold feel more at ease in his new surroundings.” The child was able to better understand and cope with her own move by using the horse as a metaphor.
Is equine therapy expensive?
I was thinking about the disparity between NCEFT’s need for fundraising and the public’s comprehension of the expenditures involved with our facility as I dropped hundreds of invites into the Roberts Market mailbox for this year’s “Jewels and Jeans Gala.” Our annual Gala raises around a fifth of our operating budget, allowing us to pay horse care, patient scholarships, facility upkeep, and a variety of other needs. Though revenue from our services (hippotherapy, therapeutic riding, etc.) helps fund NCEFT, we wouldn’t be able to treat all of the children and adults who seek therapy at our facilities without the continuing support of dedicated contributors.
Unlike most typical therapy clinics, NCEFT has a trained team that is available 24 hours a day, seven days a week.
These volunteers work 365 days a year at the institution and are compensated with food, lodging, and the occasional carrot in exchange for their efforts.
The 14 therapeutic horses in our care are critical to the success of our program, and they are treated with the utmost care.
Employing a stable of horses, on the other hand, comes with a price that may surprise you.
Let’s take a look at a therapy horse’s daily routine and discover what goes into keeping our barn functioning.
7 a.m. Horses are given an amount of grass hay based on their weight, height, and level of exercise.
8 a.m. The Barn crew starts brushing and exercising the horses who will be working that day.
Each horse gets an hour of personalized care.
9 a.m. Stalls in the barn and top stall-paddock combinations are cleaned and rebedded with new shavings.
The therapy sessions begin at 10 a.m.
A horse handler, therapist, and up to three volunteers are used in each session.
Every half-hour, up to three or four sessions may run.
12 p.m. Horses are given a special lunch that includes nutrients and medications.
Everything from supportive treatment for sensitivity to food changes to apple-flavored electrolytes is given to our horses.
5 p.m. – The day’s therapy sessions complete, and the horses are fed an evening meal comparable to their morning meal.
Depending on the type of therapy, the expense of twice daily feeding, individual grooming and exercise, stall cleaning, specialist supplemental grain, and session personnel (horse handler and therapist) adds up to between $115 and $300 per session.
Horses are incredibly perceptive to the emotions of humans, which is why these animals are effective in therapy.
Horses are able to recognize human facial expressions and prefer to approach happy faces over hostile ones. Horses are extremely sensitive to changes in human expression and emotion as a result of this sensitivity, and horse therapy is becoming a more popular avenue for emotional and physical healing as a result of this sensitivity. Hippotherapy and equine-assisted therapy are two prevalent methods of horse therapy, however they have significant differences.
Equine-Assisted Therapy vs Hippotherapy
Both therapies use horses, but they focus on distinct aspects of total wellness. Equine-assisted therapy is a type of therapy that involves patients caring for horses in a stable setting. Hippotherapy, on the other hand, is a type of physical therapy in which the patient rides a horse to improve his or her physical condition.
The occupational therapy, speech-language pathology, and physical therapy components of this horse-riding therapeutic practice are all referred to as hippotherapy.
Equine-assisted treatment addresses mental health issues such as those linked with alcohol, opiate, or cocaine withdrawal. Patients can address the emotional and mental health concerns linked with their substance use disorder by caring for horses with a mental health practitioner present. Horses’ emotional intelligence aids patients in gaining self-confidence, overcoming obstacles, and establishing long-term emotional foundations for long-term sobriety. Equine-assisted therapy has been demonstrated to promote mental wellness and even alleviate the symptoms of mental illnesses.
Finding Treatment Solutions
At Banyan Detox Boca, we provide a wide range of mental health and addiction treatment options. Equine-assisted therapy is used in our Boca drug treatment programs to help people overcome their difficulties.
If you or someone you love needs guidance in recovery, contact our treatment team by calling 888-280-4763.
- The Effects of Equine-Assisted Activities and Therapy on Resting-State Brain Function in Attention-Deficit/Hyperactivity Disorder: A Pilot Study (NCBI)
How is hippotherapy billed?
Hippotherapy should be documented with either unlisted CPT codes 97799- unlisted physical medicine or 97139- unlisted therapeutic treatment or HCPCS code S8940- equestrian/hippotherapy per session because there is no unique CPT code for it. Most payers will seek additional paperwork for review prior to reimbursement if an unlisted code is billed. Some practitioners may be charging codes 97110 (therapeutic exercise), 97112 (neuromuscular re-education), 97530 (therapeutic activities), and/or 97770 instead of the unlisted code (sensory integrative activities). Hippotherapy would likely pass through the claims processes unnoticed if reported with these codes.
Does NDIS fund equine therapy?
Equine aided treatment must satisfy the “reasonable and necessary” standard to qualify for NDIS funding. This means your request must be relevant to your impairment, cost-effective, and likely to benefit you.
It’s critical that your funding request is linked to one of your NDIS goals, therefore make sure you link the activity to your goals.
I’d meet people I’d never met before, make new acquaintances, and learn how to ride a horse by following instructions.
Riding a horse will develop my muscles and improve my ability to control my arms and hands, allowing me to do more tasks on my own.
Funding will most likely come from the Capacity Building budget in this situation. You might be able to spend your NDIS Community Participation allowance to try horseback riding to see if you like it and if you want to pursue it further.
Obtaining a letter of support from a physiotherapist or occupational therapist detailing the sort of therapy recommended and how it can help you reach your goals may be beneficial.