Can You Photograph Happiness? A Photovoice Study about the Effect of Hippotherapy on the Psychological Well-Being of Children with Cerebral Palsy from Parents' Perspective
Abstract
This study investigates the impact of hippotherapy on the psychological well-being of children diagnosed with cerebral palsy using the photovoice method. The sample consisted of 11 parents (7 women, 4 men) of children aged 3–9 years receiving hippotherapy. Individual and group interviews were conducted between April and June, and the photographs taken by parents were analyzed using the SHOWED approach and thematic analysis. The analysis revealed five physical effects (functional motor skills, physical development, independent sitting, gait, and balance) and six well-being–related themes, including perceived self-efficacy; self-confidence and sense of achievement; motivation; communication and socialization; perceptual expansion—defined as the child’s growing awareness of environmental stimuli and increased exploratory behaviors; and emotional attachment. The findings indicate that psychological well-being improves in parallel with physical development achieved through hippotherapy. This study provides important implications for practitioners, families, and service providers. Theoretically, the study expands understanding of well-being by demonstrating how parents interpret psychological change through observable physical progress. A practical policy recommendation emerging from the results is the integration of parent-generated visual documentation (photovoice outputs) into rehabilitation protocols to enhance communication between families and clinicians and to support individualized therapy planning.
Keywords: Cerebral palsy, Hippotherapy, Photovoice, Therapeutic recreation, Well-being.
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All, A. C., Loving, G. L. (1999). Animals, horseback riding, and implications for rehabilitation therapy. Journal of Rehabilitation, 65(3). ISSN: 0022-4154 WOS:000082364500008
Anderson, A. E., Hure, A. J., Kay-Lambkin, F. J., & Loxton, D. J. (2014). Women’s perceptions of information about alcohol use during pregnancy: A qualitative study. BMC Public Health, 14(1), 1048. https://doi.org/10.1186/1471-2458-14-1048
Benjamin, J. (2000). Introduction to hippotherapy. American Hippotherapy Association. Aktaran Casady, R. L., Nichols-Larsen, D. S. (2004). The effect of hippotherapy on ten children with cerebral palsy. Pediatric Physical Therapy, 16(3), 165-172.
Berninger, V. W., Gans, B. (1986). Language profiles in nonspeaking individuals of normal intelligence with severe cerebral palsy. Augmentative and Alternative Communication, 2(2), 45-50. https://doi.org/10.1080/07434618612331273880
Bertoti, D. B. (1988). Effect of therapeutic horseback riding on posture in children with cerebral palsy. Physical Therapy, 68(10), 1505-1512. https://doi.org/10.1093/ptj/68.10.1505
Biery, M. J., & Kauffman, N. (1989). The effects of therapeutic horseback riding on balance. Adapted Physical Activity Quarterly, 6(3), 221-229.https://doi.org/10.1123/apaq.6.3.221
Brown, F. L., Whittingham, K., Boyd, R. N., McKinlay, L., & Sofronoff, K. (2015). Does Stepping Stones Triple P plus Acceptance and Commitment Therapy improve parent, couple, and family adjustment following paediatric acquired brain injury? A randomised controlled trial. Behaviour Research and Therapy, 73, 58-66. https://doi.org/10.1016/j.brat.2015.07.001
Carlsson, B. (2001). Depicting experiences. Scandinavian Journal of Educational Research, 45(2), 125-143. https://doi.org/10.1080/00313830120052723
Casady, R. L., & Nichols-Larsen, D. S. (2004). The effect of hippotherapy on ten children with cerebral palsy. Pediatric Physical Therapy, 16(3), 165-172.
Cho, S. H. (2017). Effects of horseback riding exercise on the relative alpha power spectrum in the elderly. Archives of Gerontology and Geriatrics, 70, 141-147. https://doi.org/10.1016/j.archger.2017.01.011
Copeland-Fitzpatrick, J., & Tebay, J. M. (1998). Hippotherapy and therapeutic riding: An international review. Companion Animals in Human Health, 41-58.
Debuse, D., Chandler, C., & Gibb, C. (2005). An exploration of German and British physiotherapists' views on the effects of hippotherapy and their measurement. Physiotherapy Theory and Practice, 21(4), 219-242. https://doi.org/10.1080/09593980500321143
Deci, E. L., & Ryan, R. M. (2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11(4), 227–268.
DePauw, K. P. (1986). Horseback riding for individuals with disabilities: Programs, philosophy, and research. Adapted Physical Activity Quarterly, 3(3), 217-226. https://doi.org/10.1123/apaq.3.3.217
Falke, G. (2009). Equine therapy clinical, psychological and social approach. Magazine of the Argentine Medical Association, 122(2).
Frambach, J. M., van der Vleuten, C. P., & Durning, S. J. (2013). AM last page: Quality criteria in qualitative and quantitative research. Academic Medicine, 88(4), 552. https://doi.org/10.1097/ACM.0b013e31828abf7f
Granados, A. C., & Agís, I. F. (2011). Why children with special needs feel better with hippotherapy sessions: a conceptual review. The Journal of Alternative and Complementary Medicine, 17(3), 191-197. https://doi.org/10.1089/acm.2009.0229
Irwin, L., Jesmont, C., & Basu, A. (2019). A systematic review and meta-analysis of the effectiveness of interventions to improve psychological wellbeing in the parents of children with cerebral palsy. Research in Developmental Disabilities, 95, 103511. https://doi.org/10.1016/j.ridd.2019.103511
Janura, M., Peham, C., Dvorakova, T., & Elfmark, M. (2009). An assessment of the pressure distribution exerted by a rider on the back of a horse during hippotherapy. Human Movement Science, 28(3), 387-393. https://doi.org/10.1016/j.humov.2009.04.001
Kim, S. G., & Lee, J. H. (2015). The effects of horse riding simulation exercise on muscle activation and limits of stability in the elderly. Archives of Gerontology and Geriatrics, 60(1), 62-65. https://doi.org/10.1016/j.archger.2014.10.018
Lechner, H. E., Kakebeeke, T. H., Hegemann, D., & Baumberger, M. (2007). The effect of hippotherapy on spasticity and on mental well-being of persons with spinal cord injury. Archives of Physical Medicine and Rehabilitation, 88(10), 1241-1248. https://doi.org/10.1016/j.apmr.2007.07.015
Lee, C. W., Kim, S. G., & Na, S. S. (2014). The effects of hippotherapy and a horse riding simulator on the balance of children with cerebral palsy. Journal of Physical Therapy Science, 26(3), 423-425. https://doi.org/10.1589/jpts.26.423
Macdonald, D., Peacock, K., Dew, A., Fisher, K. R., & Boydell, K. M. (2022). Photovoice as a platform for empowerment of women with disability. SSM-Qualitative Research in Health, 2, 100052. https://doi.org/10.1016/j.ssmqr.2022.100052
MacKinnon, J. R., Noh, S., Lariviere, J., MacPhail, A., Allan, D. E., & Laliberte, D. (1995). A study of therapeutic effects of horseback riding for children with cerebral palsy. Physical & Occupational Therapy in Pediatrics, 15(1), 17-34. https://doi.org/10.1080/J006v15n01_02
McGee, M. C., & Reese, N. B. (2009). Immediate effects of a hippotherapy session on gait parameters in children with spastic cerebral palsy. Pediatric Physical Therapy, 21(2), 212-218. https://doi.org/10.1097/PEP.0b013e3181a39532
McGibbon, N. H., Andrade, C. K., Widener, G., & Cintas, H. L. (1998). Effect of an equine‐movement therapy program on gait, energy expenditure, and motor function in children with spastic cerebral palsy: A pilot study. Developmental Medicine & Child Neurology, 40(11), 754-762. https://doi.org/10.1111/j.1469-8749.1998.tb12344.x
Miller, F. (Ed.). (2007). Physical therapy of cerebral palsy. Springer Science & Business Media.
Moreau, N. G., Bodkin, A. W., Bjornson, K., Hobbs, A., Soileau, M., Lahasky, K., … & Barbeau, H. (2016). Effectiveness of rehabilitation interventions to improve gait speed in children with cerebral palsy: Systematic review and meta-analysis. Physical Therapy, 96(12), 1938–1954. https://doi.org/10.2522/ptj.20150401
Piaget, J. (1952). The origins of intelligence in children. International Universities Press.
Povee, K., Bishop, B. J., & Roberts, L. D. (2014). The use of photovoice with people with intellectual disabilities: Reflections, challenges and opportunities. Disability & Society, 29(6), 893-907. https://doi.org/10.1080/09687599.2013.874331
Roberts, L. T., Stein, C. H., & Tompsett, C. J. (2022). Youth views of community needs: A photovoice collaboration. Children and Youth Services Review, 139, 106563. https://doi.org/10.1016/j.childyouth.2022.106563
Ryan, R. M., & Deci, E. L. (2001). On happiness and human potentials: A review of research on hedonic and eudaimonic well-being. Annual Review of Psychology, 52, 141–166. https://doi.org/10.1146/annurev.psych.52.1.141
Shaffer, R. (1985). Beyond the dispensary. English Press. CABI Record Number: 19852023923
Simmonds, S., Roux, C., & Avest, I. T. (2015). Blurring the boundaries between photovoice and narrative inquiry: A narrative-photovoice methodology for gender-based research. International Journal of Qualitative Methods, 14(3), 33-49.
https://doi.org/10.1177/160940691501400303
Spencer, R. A., Numer, M., Rehman, L., & Kirk, S. F. (2021). Picture perfect? Gazing into girls’ health, physical activity, and nutrition through photovoice. International Journal of Qualitative Studies on Health and Well-Being, 16(1), 1874771. https://doi.org/10.1080/17482631.2021.1874771
Tercan, S., Ekinci, Ü. & Kaya, E. (2025). The effect of recreational activities and education on the quality of life of parents of ındividuals with autism. Journal of Education and Recreation Patterns (JERP), 6(1), 199-215. DOI: https://doi.org/10.53016/jerp.v6i1.286
Van Der Heide, J. C., Begeer, C. O., Fock, J. M., Otten, B., Stremmelaar, E., Van Eykern, L. A., & Hadders-Algra, M. (2004). Postural control during reaching in preterm children with cerebral palsy. Developmental medicine & child neurology, 46(4), 253-266. https://doi.org/10.1017/S0012162204000416
Yalçın, C., Altındöker, M.& Yıldız, H. (2025). The moderating role of leisure satisfaction in the effect of peer relationships on happiness in adolescents. Journal of Education and Recreation Patterns (JERP), 6(1), 1-16. DOI: https://doi.org/10.53016/jerp.v6i1.278
Walton, G., Schleien, S. J., Brake, L. R., Trovato, C., & Oakes, T. (2012). Photovoice: A collaborative methodology giving voice to underserved populations seeking community inclusion. Therapeutic Recreation Journal, 46(3), 168-178.
Wang, C., & Burris, M. A. (1997). Photovoice: Concept, methodology, and use for participatory needs assessment. Health Education & Behavior, 24(3), 369-387. https://doi.org/10.1177/109019819702400309
Whittingham, K., Sanders, M. R., McKinlay, L., & Boyd, R. N. (2016). Parenting intervention combined with acceptance and commitment therapy: A trial with families of children with cerebral palsy. Journal of Pediatric Psychology, 41(5), 531-542. https://doi.org/10.1093/jpepsy/jsv118
Winchester, P., Kendall, K., Peters, H., Sears, N., & Winkley, T. (2002). The effect of therapeutic horseback riding on gross motor function and gait speed in children who are developmentally delayed. Physical & Occupational Therapy in Pediatrics, 22(3-4), 37-50. https://doi.org/10.1080/J006v22n03_04
Wingate, L. (1982). Feasibility of horseback riding as a therapeutic and integrative program for handicapped children. Physical Therapy, 62(2), 184-186.
Woźniak, P., & Weber-Nowakowska, K. (2019). Assessment of the influence of hypotherapy on psychosocial development of children until 18 years old. Journal of Education, Health and Sport, 9(5), 280-297. http://dx.doi.org/10.5281/zenodo.3072055
Zadnikar, M., & Kastrin, A. (2011). Effects of hippotherapy and therapeutic horseback riding on postural control or balance in children with cerebral palsy: A meta‐analysis. Developmental Medicine & Child Neurology, 53(8), 684-691. https://doi.org/10.1111/j.1469-8749.2011.03951.x
DOI: https://doi.org/10.53016/jerp.v6i2.315
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