Posttraumatic stress disorder (PTSD) impacts the rehabilitation of neurological deficits stemming from traumatic brain injury, spinal cord injury, and stroke. PTSD manifests through intrusive memories, avoidance behaviors, negative mood, cognitive changes, and hyperarousal, associating neurological damage via processes like neuroinflammation, oxidative stress, and excitotoxicity. These pathophysiological mechanisms hinder neuroplasticity and contribute to structural/functional brain alterations, complicating conventional neurorehabilitation efforts. Hippotherapy emerges as an unparalleled approach in neurorehabilitation. Hippotherapy is conducted by trained health and equine professionals and utilizes the movement of the horse at a walk to promote functional recovery and well-being in individuals with disabilities. This holistic method integrates somatic, mental, emotional, and social dimensions to support PTSD handling and optimize functional outcomes after neurotrauma. By targeting interconnected multifaceted functional processes, hippotherapy stimulates neural pathways and facilitates mental and emotional regulation, thereby alleviating anxiety and hypervigilance and enhancing mood and executive functions through neuromodulator mechanisms. It also enhances body awareness, overall well-being, and social integration, mitigating feelings of isolation. Hippotherapy’s potential to significantly improve PTSD symptoms and enhance recovery trajectories for patients navigating complex neurological conditions underscores its relevance among multidisciplinary neurorehabilitation strategies.