Hippotherapy horse simulator

A motorised saddle reproducing the three-dimensional movement of a walking horse — forward and back, side to side, and rotational. Sitting on it, the pelvis and trunk are moved through the same repeating pattern the pelvis produces during walking.

The rider's postural muscles respond continuously and automatically to keep them upright. That reflexive trunk activation is very difficult to produce with voluntary exercise, which is what makes the approach distinctive.

Children with cerebral palsy, where trunk control and pelvic mobility are frequently the limiting factors for sitting and walking. Also developmental coordination difficulty, adults after stroke needing trunk control work, multiple sclerosis, and balance and posture disorders.

The simulator has practical advantages over a live horse: the movement is identical every session, speed and amplitude are adjustable, there is no allergy or animal-safety risk, and it is available year-round indoors.

It works on trunk control, pelvic mobility, postural response and sitting balance. It is not a treatment for the whole condition and it does not train walking directly.

Children engage with it readily, which is a genuine clinical advantage — a session completed is worth more than a better exercise refused. But engagement is not an outcome, and we measure the trunk control it is supposed to change.

The simulator reproduces the three-dimensional movement of a horse’s walk, which provides continuous trunk and pelvic input without an animal, a stable or the associated risk.

It is used mainly in children with cerebral palsy for trunk control and postural response. Evidence is more limited than for mainstream approaches and we describe it accordingly.

A 2022 meta-analysis gathered twelve small clinical trials involving 343 children with the spastic diplegic form of cerebral palsy 1. Adding simulator sessions to physiotherapy improved overall gross motor function, sitting ability and functional balance more than physiotherapy alone, and the simulator increased how far the hips could open compared with a sham treatment 1. Standing and walking scores, measured in two trials, did not improve more than with physiotherapy alone 1. Compared with sham, however, gains in sitting and overall motor function were not significantly greater, and no clear effect on spasticity was found 1.

Used instead of physiotherapy rather than added to it, the simulator did not produce significantly greater gains in overall motor function 1. Programmes lasted from one to twelve weeks, the risk of bias in the trials was moderate, and none of them followed children up after treatment ended 1. The fair summary is that the simulator can add useful practice of trunk and sitting control to a physiotherapy programme, but it has not been shown to replace active therapy.