Therapies Saddled With Burden of Proof : Medicine: Horseback riding, snorkeling and hiking help patients regain ability, experts say. But insurers want to see more data before covering costs.

A sudden rain shower sends 9-year-old Lauren Boynton running into some nearby stables, seeking cover on a midsummer day after berry-picking and a romp through a lawn sprinkler.

She carries one crutch--bright pink, her favorite color--but doesn’t really use it.

Eighteen months ago, Lauren could barely sit upright in a chair because of cerebral palsy. She used a walker or two crutches.

Getting her out of a hospital rehabilitation room and onto horseback made all the difference, say those who treat her.

“A kid who gets tired after 20 minutes in a hospital--here I can get an hour out of him,” said Edie Tomasko, executive director of UpReach Therapeutic Riding Center, where Lauren rides.

Physical therapists are putting into practice what many healthy people have always known: Taking a hike in the woods or going snorkeling is more fun than walking on a treadmill in a gym, tugging on weights or doing other repetitive exercises in a hospital or rehabilitation center.

“Therapists have always been looking for ways to make people more active so they don’t say, ‘I lost my leg and my life is over,’ ” said Jim Coombes, executive director of the National Amputee Golf Assn.

Despite the progress of patients like Lauren, however, some insurance companies are wary of paying for recreational therapy, saying not enough research has been done to prove such activities work.

“We have to have published reports,” said Susan Leahey, a spokeswoman for Blue Cross and Blue Shield of Massachusetts. “We would need a track record of statistics, data and results. None of that is done yet.”

Leahey’s company, which covers about 2 million people, does not pay for horseback riding, snorkeling or other types of physical therapy done outside a hospital or conventional rehabilitation center.

ITT Hartford Life Insurance Cos. of Simsbury, Conn., has sponsored outdoor wilderness experiences for people injured on the job and is willing to try other alternative therapies, said spokeswoman Marnie Goodman.

“We have found it makes a lot of financial sense to look at a variety of ways of getting people back to work,” Goodman said. “We are looking very deeply into these activities.”

ITT’s group disability plan covers more than 1.5 million workers nationwide.

Richard Coorsh, spokesman for Health Insurance Assn. of America, an industry group, said most private insurers will look at doctors’ recommendations on a case-by-case basis.

UpReach treats people with such disabilities as cerebral palsy and cystic fibrosis, as well as amputees and stroke victims.

People who ride the horses at UpReach have a doctor’s prescription. They mount horses using a wheelchair ramp, then ride with a volunteer on either side and a third person leading the horse.

Riding is the closest exercise to walking, Tomasko said. The horse’s gait rotates the patients’ hips, forces them to use their trunk muscles for balance and warms the muscles. Brushing the horse after riding strengthens arm muscles.

Hippotherapy, as horse therapy is known, is just one of a growing number of alternative therapies.

Tim Skelly, coordinator of water services at St. David’s Rehabilitation Hospital in Austin, Tex., teaches snorkeling for pain management and spinal cord injuries because water allows people to get into positions they can’t achieve on land and helps patients stay fit so they don’t end up in a hospital again.

Practitioners of alternative therapy acknowledge there is a lack of research on the effectiveness of such exercise.

“There’s no proof that [hippotherapy] is better, but I’d bet my house on it,” Tomasko said.

Sandra Houle, a physical therapist who runs the New England Rehabilitation Hospital’s riding program, said the hospital has to show the therapy has enabled patients to do such things as getting out of wheelchairs or living independently before it can get insurance payments.

Lisa Culver, a spokeswoman for the American Physical Therapy Assn., said many insurance companies are being too cautious. “They are looking at a horse or a pool instead of at the techniques being applied.”

“The insurance companies have a very narrow view of physical therapy--a kid lying on a mat and exercising their arms and legs,” said Sherry Mayo, whose autistic daughter, Stephanie, rides at UpReach. “We just write a check for $40 every week. The insurance companies need to see that this works.”