DESCRIPTION
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.
POLICY
Hippotherapy for the treatment of ALL conditions/diseases, including, but not limited to, the following is considered investigational:
Neuromusculoskeletal dysfunction associated with cerebral palsy
Cerebral vascular accident
Developmental delay
Down syndrome
Functional spinal curvature
Learning or language disabilities
Multiple sclerosis
Sensory integrative dysfunction
Traumatic brain injury
IMPORTANT REMINDERS
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan or government program (e.g., TennCare), the express terms of the health plan or government program will govern.
ADDITIONAL INFORMATION
Evidence is lacking to determine if hippotherapy has a clinically significant treatment impact. No published studies are available addressing long-term efficacy.
SOURCES
American Hippotherapy Association. (2021). Statements of best practice for the use of hippotherapy by occupational therapy, physical therapy, and speech-language pathology professionals. Retrieved August 25, 2022 from https://www.americanhippotherapyassociation.org/.
BlueCross BlueShield Association. Evidence Positioning System. (4:2023). Hippotherapy (8.03.12). Retrieved September 25, 2023 from www.bcbsaoca.com/eps/. (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.
Guindos-Sanchez, L., Lucena-Anton, D., Moral-Munoz, J.A., Salazar, A., & Carmona-Barrentos, I. (2020). The effectiveness of hippotherapy to recover gross motor function in children with cerebral palsy: A systematic review and meta-analysis. Children, 7 (9), 106. (Level 1 evidence)
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.
Menor-Rodriguez, M.J., Martin, M.S., Sanchez-Garcia, J.C., Montiel-Troya, M., Cortes-Martin, J., & Rodriguez-Blanque, R. (2021). Role and effects of hippotherapy in the treatment of children with cerebral palsy: A systematic review of the literature. Journal of Clinical Medicine, 10 (12), 2589. (Level 2 evidence)
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)
ORIGINAL EFFECTIVE DATE: 9/11/2005
MOST RECENT REVIEW DATE: 11/9/2023
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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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