The social functioning domain is influenced by various factors such as education, socioeconomic status, cognition, communication abilities and motor function. The opportunity to use or practice communication, listening and language skills during hippotherapy may have resulted in the improvements observed in PEDI social functioning, in line with Casady and Nichols- Larsen’s report.
On the other hand, actual performance in daily life is influenced not only by physical environment, but also by personal and social factors. The significant PEDI gains suggest that hippotherapy enhances the child’s motivation and willingness for participation in an activity.
Although functional level may affect the gross motor outcome after hippotherapy, our sample size was insufficient to group children according to GMFCS level. This stratification would be important to select children who would benefit most from the therapy. In addition, the benefits of hippotherapy on the GMFM observed in our study were modest. This may be due to the wide range of functional disability levels of the participants.