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Therapeutic riding is the use of horses and equine-assisted activities in order to achieve goals that enhance physical, emotional, social, cognitive, behavioral and educational skills for people who have disabilities. It not only focuses on the therapeutic riding skills but also the development of a relationship between horse and rider. It uses a team approach in order to provide treatment for the individual with the guidance of riding instructor.

History
Horses have been utilized as a therapeutic aid since the ancient Greeks used them for those people who had incurable illnesses. The benefits of therapeutic riding have been dated back to 17th century literature where it is documented that it was prescribed for gout, neurological disorder and low morale.

The term therapeutic riding was originally used in Germany to address orthopedic dysfunctions such as scoliosis. The physician would engage a physical therapist and a specially-trained horse and instructor to address the strength and orthopedic dysfunction for one year, after which the patient was discharged. The physical therapist worked with the physician and the patient to attain the patient's goals, and the instructor was responsible for the horse. This later became known as hippotherapy in the US.

Therapeutic riding techniques used today started with Liz Hartel from Denmark. Her legs were paralyzed from polio but with therapy she was able to win the silver medal for dressage in the 1952 Olympic Games. The first riding centers in North America began in the 1960's and the North American Riding for the Handicapped Association(NARHA) was launched in 1969.

The horse as a therapeutic aid
Horses provide a unique neuromuscular stimulation when being ridden through their one of a kind movement. Horses move in a tree-beat rhythmic motion that mimics the human movement of walking. While riding, the horses stride acts to move the rider's pelvis in the same rotation and side-to-side movement that occurs when walking. The horses adjustable gait promotes riders to constantly adjust the speed to achieve the desired pelvic motion while promoting strength, balance, coordination, flexibility and confidence. One does not have to ride to achieve the desired effects of therapy. Horses can act as an aid by giving those with disabilities a companion to care for. Grooming such as brushing, bathing, and currying aid in joint range of motion and have a relaxing and calming effect.

Benefits of therapeutic riding
The amount of benefit gained through therapeutic riding differs from person to person based on many factors such as the type of disability, severity of disability, motivation of the rider and connection between horse and rider. Unlike exercise machines that only focus on one muscle group at a time and do not use natural body movements, riding forces the rider to make use of the entire body to steer, control, adjust the horse and maintain balance. Because horses require not only physical skill but also cognitive skill for achievement, riding reveals the strengths and weaknesses of the rider. While most traditional therapeutic techniques often reach a plateau where the patient may lose motivation, the pleasure and excitement of riding acts to encourage patients to work through the pain and discomfort. The act of accomplishing something many able-bodied people are afraid to try is a benefit to those with disabilities in itself.

In an eight week study on the effects of a therapeutic riding program with participants ranging from ages 10 to 40, a significant change in four out of eight measures of sitting posture was shown. In addition, the results of a recent a ten week study on therapeutic riding showed and improvement in sense of self-efficacy and self-esteem in adults ages 26 to 46 with psychiatric disabilities. Similarly, an additional study of 22 adults ages 17 to 6 with a variety of physical impairments reported increased physical self-efficacy and behavioral self-confidence following a 12 week therapeutic riding program.

Physical

 * Improved balance and muscle strength
 * Improved coordination and faster reflexes
 * Increased muscular control
 * Improved postural control
 * Decreased spasticity
 * Increased range of motion of joints
 * Stretching of tight or spastic muscles
 * Increased endurance and low-level cardiovascular conditioning
 * Stimulates Sensory integration
 * Improved visual-spatial perception
 * Improved gross and fine motor skills

Psychological

 * Improved self-confidence
 * Increased self-esteem and self image
 * Development of patience
 * Emotional control and self-discipline
 * Expansion of locus of control
 * Improved risk-taking abilities
 * Sense of normality
 * Socialization and improved interpersonal skills
 * Increased perception of quality of life and life satisfaction
 * Stress reduction

Educational

 * Learning horseback riding knowledge and skills
 * Learning safe behaviors for riding

Types of disabilities and conditions that can be helped by therapeutic riding
There is a very wide variety of disabilities that can benefit from the therapy provided through horseback riding including:
 * ADD/ADHD
 * Traumatic brain injury
 * Spinal cord injury
 * Stroke
 * Multiple Sclerosis
 * Muscular dystrophy
 * Cognitive Defects
 * Autism
 * Amputations
 * Cerebral palsy
 * Spina bifida
 * Mental retardation
 * Behavioral problems
 * Learning disabilities
 * Emotional problems
 * Hearing, speech and visual impairments
 * Orthopedic conditions

Therapeutic riding exercises

 * Mounting and dismounting the horse
 * Sitting on the horse using proper posture
 * Riding forward
 * Extending arms overhead
 * Extending arms outstretched to side
 * Holding arms outstretched forward and then overhead, with pole or stick grasped with both hands
 * Swinging arms alternatively forward and backwards
 * rotating the trunk with arms outstretched
 * standing in the stirrups
 * turning side to side while sitting
 * reaching to touch horses ears or tail
 * lying back on horse's back, then returning to sitting position
 * reaching down to touch left and right stirrup
 * sitting the trot
 * Advanced: riding without stirrups, riding independently, cantering, maneuvering the horse in a pattern, trotting over poles

In the United States and Canada
The Professional Association of Therapeutic Horsemanship (PATH) accredits centers providing a variety of beneficial services to people with disabilities. The Equine Assisted Growth and Learning Association (EAGALA) focuses more on the mental-health aspects of human-equine interaction, and provides certification for mental-health and equine professionals.

PATH divides these services into two general categories – "Equine-Assisted Activity" and "Equine-Assisted Therapy". Equine- assisted activities are those services provided by a trained professional and focus on recreation, leisure, sport or education. Examples of equine-assisted activities are therapeutic horseback riding, carriage driving, vaulting and equine-facilitated learning. These activities are based on an educational model; skills are taught to riders, vaulters and students. The professional guiding the experience is a specially-trained, PATH-certified instructor. The professionals’ training provides them with expertise in specialized, adaptive teaching methods which allow people with a variety of disabilities to learn horsemanship skills and experience the equine environment.

In Canada, centers and instructors are regulated by CanTRA, also known as The Canadian Therapeutic Riding Association.

Autism
Therapeutic horseback riding has been used to help people with autism. Especially for autistic children. This activity is said to benefit the communication, motor skills, and social skills of an autistic person. It also causes improvement in responses to verbal and external stimuli and relaxation. People with autism cannot ignore one sense and let another take over the way most people can. Instead, they see, smell, hear, taste, and feel, and think all at once giving them sort of a sensory overload that they cannot handle. Riding a horse helps them concentrate on just the task they are doing rather than everything all at once.

Equine assisted activities work almost like a reward system. When a child with poor communication skills wants the horse to walk they have to use a verbal command to move the horse forward it gives them incentive to give that command. Also, they will begin to build a bond with the horse and also with the handlers of that horse. Although the horses are led during lessons they learn to pull the reins to move the horse to one direction or another. These could be reaching down to grab something or giving the handler a high-five. Individuals with autism will learn to interact with the horses handlers to convey to them what they want the horse to do. If they want the horse to walk they have to learn from the handler how to ask the horse to do that. Also, it helps them to focus on something outside from themselves which is a difficulty for people with autism.

Safety
Many people might ask if it’s safe for someone with poor motor and communication skills to ride a horse. But while there are always some risks involved every precaution is taken. There are side walkers who help to stabilize the child and the horse is matched to the rider’s ability level. Proponents argue that the benefits of therapeutic riding by far outweigh the risks. Despite its broad and beneficial effects, therapeutic riding may not be the appropriate therapy for some people with disabilities. A medical history, health care provider’s statement of approval and recommendations are necessary before an individual can participate in therapeutic riding activities. Health care information enables the riding instructor(s) to prepare for individual's needs, plan supervision, and ensure riders’ safety.

Disabilities that do not benefit from therapeutic riding

 * Unhealed pressure sores
 * fragile bones
 * bleeding disorders
 * Epilepsy(uncontrolled by drugs)
 * Lack of desire to ride(after trial experience)
 * Allergies