Hippotherapy in adults with acquired brain injury: A systematic review. 
Hippotherapy is used to supplement conventional therapy in neurological conditions with evidence supporting its use in pediatric patients.  However, evaluation of its merit in adults with acquired brain injury (ABI) is lacking.  The aim of this study was to determine if hippotherapy can improve motor function in adults with ABI.  A systematic review of all available controlled studies investigating the use of hippotherapy, in adults with ABI, was conducted.  The primary outcome of interest was movement related function and secondary outcomes included impairment, quality of life, and adverse events.  Nine studies with 256 participants were included, of which six studies with 204 participants were included for meta-analysis.  When the data were pooled, hippotherapy did not produce statistically significant improvements in balance (SMD = 0.24, 95% CI -0.05, 0.54, p = 0.1) or gait parameters (SMD = -0.04, 95% CI -0.79, 0.72 p = 0.92) when compared to control and measured immediately after the intervention.  Long-term effects remain unknown due to lack of follow-up evaluation.  This review suggests that hippotherapy is safe and well tolerated by adults with ABI.  Short-term functional benefits were not associated with the use of hippotherapy.  Further high-quality research is required before hippotherapy can be endorsed as a modality in adult neurological rehabilitation.