Hippotherapy in neurodevelopmental disorders: a narrative review focusing on cognitive and behavioral outcomes.

Hippotherapy (HT) is a rehabilitative tool inducing psychological and motor improvements using human-horse interaction. HT provides sensory stimulation to the rider through the rhythmic and repetitive movements of the horse, facilitating communication between patients and healthcare professionals, favoring the establishment of a therapeutic alliance. The purpose of this review is to evaluate the effects of HT treatment on cognitive-behavioral processes in neurodevelopmental disorders. We screened studies published between 2002 and 2020 on PubMed, Scopus, Cochrane, and Web of Sciences databases. The search combined the following terms: "hippotherapy"; "horseback riding"; "equine-assisted therapy"; "developmental disorder"; "autism spectrum disorder"; "dyspraxia"; "infantile cerebral palsy"; and "attention-deficit/hyperactivity disorder". This review shows that HT can be a valuable tool for the treatment of developmental disorders. The psychological, cognitive and relational areas could benefit from the animal-child interaction to promote child autonomy, self-esteem, self-efficacy and openness to others. Physical, motor and psychosocial benefits were found in adolescents with anxiety and/or depression disorders, in autism spectrum disorders, dyspraxia, as well as in infantile cerebral palsy and attention deficit hyperactivity disorder. HT could be considered an alternative therapeutic tool thanks to the relationship between patient-horse-instructor and to the sensory-motor and cognitive stimulation that enforce learning processes.