Benefits of Animal-Assisted Interventions (PA)

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There is no doubt that the bond between a person and their dog is something special. In fact, humans have likely benefited from special relationships with the modern day dog’s ancestors since pre-historic times. Paintings discovered in caves depicted the crucial role dogs played in hunting and gathering with early man. But the real relationship developed once man experienced physical and emotional benefits from the bond developed with dogs in modern times. Beyond offering companionship and becoming part of the family, dogs have become important to our health.

A search of the internet conducted in March 2015 found a list of studies on the Pet Partners website taken from a Chapter out of “Compassion: Our Last Great Hope-Selected Speeches of Leo K. Bustad, DVM, Ph.D. published by Delta Society 1996”. These studies helped define the benefits of animals on human health:

1. Higher one-year survival rates following coronary heart disease (Friedmann et al, 1980; Friedman and Thomas, 1995)

2. Reduction in blood pressure and stress level in healthy subjects, as well as changes in speech pattern and facial expression, and lower plasma triglyceride and cholesterol levels (Baun et al., 1984; Katcher et al., 1984; Katcher, 1987; Wilson, 1991; Allen et al., 1991; Anderson et al., 1992)

3. Improvement in quality of life for elderly persons (Robb, 1987; Stallones, 1990)

4. Socialization of young children with their peers (Hart et al, 1987; Nielsen and Delude, 1989)

5. Development of nurturing behavior and humane attitudes in children who may grow to be more nurturing adults (Melson, 1990; Ascione, 1992)

6. More appropriate social behavior in mentally impaired elderly people and prisoners (Burke et al, 1988; Jecs, Dawn, personal communication; Lee, David, personal communication; Hendy, 1984; Katcher et al., 1989)

7. Success in psychotherapy sessions and in psychiatric institutions in helping patients work through their anxiety and despair (Peacock, 1984; Beck et al., 1986; Holcomb and Meacham, 1989)

8. Improved balance, coordination, mobility, muscular strength, posture and language ability as a result of therapeutic horseback riding (ITRC, 1988; Biery and Kauffman, 1989; Dismuke, 1984)

9. Reduction in the demand for physicians’ services for medically non-serious problems among Medicare enrollees, and an apparent buffering effect against psychological stress (Siegel, 1990; Siegel, 1993)

10. Facilitation of social interaction between strangers (Hunt et al., 1992)

11. Highly significant reduction in minor health problems and highly significant improvement in psychological components of general health, plus a dramatic increase in recreational walks by dog-owners (Serpell, 1991)

12. Encouragement of preadolescents’ emotional reciprocity and caring responsibility, as well as lessening feelings of loneliness (Davis and McCreary Juhasz, 1995)

In the 2011 article “Animal-Assisted Interventions in Internal and Rehabilitation Medicine: A Review of the Recent Literature” by Muñoz Lasa, S.; Ferriero, G.; Brigatti, E.; Valero, R.; Franchignoni, F. in Panminerva Medica, a literature review of articles written between 2001-2010 was conducted that included thirty-five articles. 18 papers dealt with AAA, 8 with AAT, and 9 with Service Animal programs (SAP). The therapeutic outcomes according to this review that were associated with AAA included: “enhancement of socialization; reduction of stress, anxiety and loneliness; improvement in mood and general well-being; and development of leisure/recreation skills.”

The eight articles dealing with AAT found that horses are often used as a complementary strategy to decrease tone and spasticity, especially in children with Cerebral Palsy. Service animals increased the ability to perform ADL’s in people with a wide variety of disabilities ranging from guide dogs for the visually impaired to assistive dogs for people with paralysis. This literature review concluded that more research is needed to better define how animals are best used for therapeutic value in different areas of healthcare.

In “Measuring Clinical Outcomes of Animal-Assisted Therapy: Impact on Resident Medication Usage”, Lust et. al. a study was conducted on 58 residents of a rehabilitation facility that measured the change in medication usage after exposure to a certified, trained therapy dog. The study concluded that the presence of a therapy dog had the potential to decrease the use of medications for certain diagnoses in long-term care patients. The results of the decrease in medication led to a decrease in the cost associated with the care for those patients.

Animals have held a key place in history when defining happiness, healing and adding quality to social situations. Pets serve as a socializing agent for children and the mentally ill, a therapeutic benefit for the sick and a companion for the lonely or isolated. By the nineteenth century, these benefits have allowed animals to become a more common fixture in healthcare facilities. Despite all the positive findings, there are many healthcare facilities and settings in the United States that do not have animal-assisted programs. The possible reasons for the slower development of animal-assisted therapy programs in those institutions may include: the lack of knowledge and/or resources to start a program, safety & perceived risks, administrative concerns, HIPAA concerns with the involvement of a handler, lack of availability of dogs/animals for a program, and the cost to sustain the program.

In spite of the fact some places do not have animal-assisted programs because of the barriers listed above, there are many places that the role of dogs in physical, occupational therapy and speech therapy has become more mainstream over the past few decades. While other animals can be used in therapy, dogs tend to be the easiest animal to integrate into a program. For the purpose of our discussion, we will focus on the use of dogs and how to incorporate them into therapy programs. We will explore both obvious and subtle reasons to use animals in your program and discuss in detail how to apply the animals in a therapy program.

With reimbursements from many payors declining year over year and the increase in the patient responsibility portion of healthcare bills, therapists are under pressure to achieve functional goals faster than ever before. The increase in patient responsibility creates the need for value added service. If someone has a high copay they want to feel they are getting “ their money’s worth” in each therapy session or they are likely to decide they can do therapy on their own. Adding a dog into therapy sessions can create that value added perception. If affordability of therapy is an issue to an individual and you can increase patient compliance by using a pet in therapy then, as a therapist, you have a better chance of achieving your goals with the patient.

Physical, occupational and speech therapists alike are always seeking innovative new ways to get their patients to meet their functional goals. It is important to remember that the health of a patient can be enhanced with animal interventions in physical, social or psychological realms. All of these areas play a role in the healing of a patient and are a vital part of the process.

We have cited studies that recorded a reduction in blood pressure and heart rate with the use of animal-assisted therapy. Stress reduction can allow a patient to thrive in a rehab program. A patient that is unwilling to participate will not have an optimal outcome. If using a dog can reduce the patient’s stress and anxiety the patient is more likely to benefit from treatment sessions.

Armed with a variety of ideas and exercises, physical, occupational, and speech therapists constantly strive to find creative ways to get a few more degrees of motion in someone’s shoulder, a little better gait pattern in a child with a neurological condition, increased cognitive awareness when working with a resident of a nursing home, or an improved speech pattern in a child with developmental delays. These seemingly small events are often huge milestones on a patient’s road to recovery and can be the catalyst for someone living an independent life, getting back to a hobby they love, or just getting to hold a small child that is a part of their life.

The interesting thing about using a dog or any animal in therapy is that they can be used in an inpatient or outpatient setting, and can be used at various points of the rehabilitation process. A stroke patient that has some social withdrawal immediately following their stroke can benefit from the dog’s presence to gain confidence and motivation. Throwing a ball to a dog may be introduced late in a program for that same stroke patient or early on in a program for a child with developmental delays. The flexibility in using animals across the spectrum of care makes them a great tool for therapists.

Baylor Health, according to their website March 15, 2015, has over 90 dogs in their system that work 1 to 4 hours to volunteer their time in various departments. Their website cites many of the benefits we have addressed. The website also refers to the benefits with head injury patients by encouraging them to speak during the phase post injury when they are apprehensive to attempt to speak or getting frustrated with the difficulty they are having with their speech.

Most therapists will gladly share stories about the creative things they have thought up in order to get a patient to meet their rehabilitation goals. In our quest to encourage people to do more every day in therapy, man’s best friend may also be a therapist’s best friend. There is story after story about amazing results obtained after interactions between animals with both children and adults. Two special interactions are listed below:

  • Logan, an English Cocker Spaniel, was a C.A.T. certified pet therapy dog who visited retirement and nursing homes as his job. One Alzheimer’s patient was very special for Logan. Each time Logan visited the facility, the gentleman’s daughter was always there. She was always amazed by her father when Logan came to visit because he never remembered his daughter’s name who was there every week, but he always knew the name of his favorite visitor, Logan.
  • Dillon is one of two founding dogs for Canine Assisted Therapy, Inc. (C.A.T.). Being a Leonberger and a gentle giant weighing in at 150 pounds, Dillon enjoyed his work with disabled adults, particularly individuals with Cerebral Palsy and traumatic brain injury. Dillon worked weekly at an adult daycare for disabled individuals and participated in activities that helped these individuals to work on their fine and gross motor movements. Most of the time, the individuals would brush Dillon; give him treats; place items into his doggy backpack and then retrieve them. One young woman, whom Dillon had been working with for several years, was asked by her physical therapist to attempt to walk in a walker. After being confined to a wheelchair for her entire life, this young woman knew that this activity would result in a lot of pain and discomfort and she refused. However, after her therapist asked if she would walk in the walker if she could walk with Dillon, she agreed. This young woman had been confined to her wheelchair for over 40 years! This was the first time that she had agreed to walk in a walker for therapy. Although everyone knew that she had to be in significant pain, she held on to the leash tightly and walked Dillon with a huge smile on her face. She was very upset when she had to go back to her chair at the end of the therapy session. No one can even begin to imagine the joy that comes from seeing someone take their first steps, throw a ball for the first time, or hold on to a brush to groom a dog. What most of us take for granted is a major and sometimes life changing accomplishment for many individuals with challenges. To see the huge smile on this young woman’s face and to know that it was Dillon who was able to provide the encouragement and motivation for her to take her first steps, is something that cannot be expressed with words.

Time and again there are stories about patients who sit unresponsive in wheelchairs in nursing homes or rehab facilities until a therapy dog enters the room, or stories about the stroke patient who hasn’t used his right arm since his stroke reaching out with that very arm to pet the therapy dog walking past him.

Children have also been involved in some remarkable stories when dogs become part of their rehab programs. There are many stories by therapists that recount the therapeutic affects of children interacting with animals. Therapists in pediatric settings have seen a reduction in the tone in a child with spasticity after petting a dog. There are programs across the nation in libraries, schools and in rehab settings that have children read to dogs to build their confidence and decrease the anxiety of reading to others. The child that struggled to read out loud to a class of their peers suddenly feels more secure to tackle reading in front of the class after these sessions of reading out loud to the dog.

We have explored the history of the animal-human bond and the many studies that revealed health benefits experienced by humans because of this relationship between animals and humans and we have also seen success in the rehabilitation process by using animals. So, how do we effectively and efficiently integrate animals in all facets of rehab to continue to improve our results?

The objective of this section is to explore how animals can impact rehab sessions and how we can integrate them in a safe and productive manner. Once programs continue to grow and expand, more data can be collected for studies on the efficacy of these programs. For the purpose of narrowing the topic we will focus mainly on the use of dogs in animal-assisted therapy, although there is merit to the use of other animals in these programs. Practicality often lends best to use of dogs in healthcare settings.

Physical and occupational therapists have integrated animals into their treatment protocols to facilitate the improvement in functional skills and activities of daily living in a variety of ways. Advance Healthcare Network posted an article June 24, 2014 by Peggy L. Gurock, OTR and Noah D. Gurock “Animal-Assisted Therapy. Four legged friends bring smiles to children with complex therapy needs”. The article states that although specific figures are limited for the number of dogs used in occupational therapy practices there appears to be a growing number of occupational therapists using dogs in their treatment plans. Although the article doesn’t specifically mention physical therapy we can extrapolate similar findings from literature.

As we mentioned earlier, dogs are used in different ways and in different settings. When working with children or adults the therapist can come up with creative and fun ways of integrating a dog into the patient’s plan of care to help them reach their therapy goals. Some dogs are part of animal-assisted activities and are used as visitors to stimulate social interaction with patients. Even though this is not a formal goal oriented approach, the benefit of a patient petting a dog walking by or tossing a ball to a dog should not be discounted in it’s true overall therapeutic value. These kinds of activities can be a precursor to getting the patient motivated for other therapeutic interventions with specific goals down the road.

Dogs that are used specifically in animal-assisted therapy can be used to improve gross and fine motor skills. While the same animal can be used across disciplines, the goals of the activity may vary. That flexibility that we mentioned earlier in this course makes the dog a valuable tool for therapists. For example, the physical therapist can use a dog in his or her treatment plan to increase strength, range of motion, balance, or improve gait. The occupational therapist may use the dog to improve ADL’s (activities of daily living) such as self-care and self-maintenance to improve the quality of life. A recreational therapist may have a patient play with an animal in their treatment to provide leisure activities. Speech therapists may use the dog to facilitate communication in their patient who presents as non-verbal. If you compare a dog to a modality or technique in therapy the intent of the exercise and goal you are working toward dictates the outcome. The documentation of the activity should include the intent and goal addressed for clarity.

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