The setting for physical, occupational or speech therapy is typically a clinical environment — not an outdoor, fenced-in area. But that's where children in Kodiak, Alaska, receive therapy every summer with the help of 1,000-pound assistants sporting glossy coats. It's called hippotherapy, a practice in which horses or ponies are part of the treatment.

Hippotherapy helps people with issues including those involving neurological function, cognition and muscle tone, says Amy Stohl, an occupational therapist at Providence Kodiak Island Medical Center. The hospital is part of Providence St. Joseph Health, which helps support Kodiak's Therapeutic Riding and Equine Assisted Therapy Program.

"You're using the horse as your equipment," Stohl explains. "The horse and the human body are a natural match in their movement."

'He just melted'
Participants in the Kodiak program include children with autism, developmental delays, learning or sensory processing difficulties and motor coordination challenges. Each session begins with grooming the horse in order to help participants become comfortable and develop motor, cognitive and language skills.

Stohl, who's also the program's co-coordinator, recalls a boy with autism. He had limited communication and was nervous about interacting with his horse — a fear he expressed through loud vocalizations. She spent 45 minutes trying to get him to warm up.

"And when he did get on the horse, it was like he just melted," Stohl says. "It's a magical connection they build with the horse — it's like they become one."

As he relaxed, his vocalizations transformed into a humming sound. "He ended up not wanting to get off," Stohl recalls.

While hippotherapy involves a therapist using a horse's movement in service of therapeutic goals, therapeutic riding involves certified riding instructors teaching people with disabilities how to adapt to a horse. Equine-assisted therapy is an umbrella term which encompasses both specialties.

Barbara Zimmerman, a certified riding instructor and co-coordinator of the Kodiak program, recalls a participant with cerebral palsy. Riding relaxed his tight leg muscles so much that they remained loosened for several days. Like many children, he formed a deep relationship with his pony.

"After his last session, we brought the pony over to tell him goodbye," Zimmerman says. "And that pony put her head on his lap and he gave her a hug."

Tested and trained horses
Therapy horses and ponies are thoroughly trained and tested. They must be gentle and able to withstand the noises and tools that accompany hippotherapy, Zimmerman says. These include tambourines, bouncing balls and bubbles, which are used for a variety of therapeutic reasons.

It's not unusual for a child to be fearful at first. They may be afraid of the horse itself or have other concerns, such as a fear of heights.

"We started one girl out with a very small pony but by the end of our program, she was riding one of the biggest horses," Zimmerman says.

Many children have ongoing conversations with their horses.

"When they're done riding, they tell the horse 'Thank you,' and 'I'll see you next week,'" Zimmerman says. "I don't think we've had a child who doesn't absolutely love it."

Parents see real changes in their children after participating, Stohl says. At the end of each session, families take home a book of pictures of their children riding and interacting with the horses.

"It's very emotional for them to see how much their child can accomplish and how much joy it brings," Stohl says.

Rewarded with smiles
The monthlong program serves around 20 children each summer. Providence's support includes providing an occupational therapist along with regular funding. Since the program's onset two decades ago, the hospital system has frequently contributed $1,000 a year. In 2023, Providence approved a $10,000 grant request. Some of that will be used to train a new therapeutic riding instructor.

Zimmerman has mixed feelings about eventually turning over the reins. But at 75, she also knows the time is not far away. Zimmerman and Stohl, who is nearing retirement, want to see the program thrive and even expand long after their involvement. "That's the dream," Zimmerman says.

"I love working with the children, the horses and the volunteers," Zimmerman says. "I love seeing the smiles on everybody's faces."

Many volunteers are with Kodiak's 4-H youth development program. Madison Welch began volunteering when she was in grade school. She helped set up the arena, create interactive games, and assist kids in grooming horses. Welch loved it even though the work was far from glamorous. "One of the jobs was picking up horse droppings," Welch says.

Welch volunteered all through high school. Working with the children was so inspiring that she decided to help people as a career. In 2021, she completed her training to become a physical therapist.

"It was really special seeing the children make so much progress in such a short time," Welch says. "And the happiness it brought their parents and siblings."