We have developed a mechanical horseback riding simulator for the rehabilitation of children with neurological and musculoskeletal disabilities, focused on improving trunk control in this population. While overseen by a physical or occupational therapist, the movement of a horse is often used as therapy for these patients (hippotherapy). However, many children never have the chance to experience hippotherapy due to geographical and financial constraints. We therefore developed a horseback riding simulator that could be used in the office setting to make hippotherapy more accessible for our patient population. The system includes a motion platform, carousel horse, and tracking system. We developed a virtual reality display which simulates a horse moving along a pier. As the horse moves forward, other horses come toward it, and the patient must lean left or right to move out of the way. The tracking system provides the position of tracking markers which are placed on the patient’s back, and this information is used to control the motion of the horse. Under an Institutional Review Board (IRB) approved trial, we have enrolled two patients with cerebral palsy to date. This was after completing testing on five healthy pediatric volunteers as required by the IRB. Early results show the feasibility of the system.