Diagnosed with autism as a toddler, Geoffrey Arnwine struggled with this condition at a time when the term was still relatively unknown. Already estranged from social interaction with people, 5-year-old Geoffrey was also terrified of dogs, which drastically limited his involvement with those outside of his immediate family. In an effort to desensitize him, his mother, Bonnie, brought him to the Humane Society in hopes that close proximity to dogs would allow him to become less fearful.

In the entrance of the building, there was a birdcage flanked by signs warning visitors not to pet the formerly abused white cockatoo inside – or he would bite. As Geoffrey and his mother were passing the cage, another visitor chimed “Hello, Oliver”, to which the bird responded “hello”. Geoffrey was immediately captivated by the bird’s funny voice. When told that Oliver also liked music, Geoffrey spent a half an hour singing the “happy birthday” song to him – the most animated interaction he had ever had.

Although the Humane Society building was hours away from where Bonnie lived, she felt this was too beneficial to pass up, and coordinated trips to bring Geoffrey to see Oliver every couple weeks. Geoffrey’s speech and language pathologist and behaviorist were unable to attend these makeshift “sessions”, but they nonetheless encouraged visiting Oliver if it meant making progress with Geoffrey’s therapy.

“We started to teach Geoffrey things he could say to Oliver – ‘Hello Oliver’; ‘Bye Oliver’; ‘I'm happy’; ‘How are you?’; ‘You make me happy’ – in his behavioral program,” says Bonnie Arwine, now the author of Starting Sensory Integration Therapy: Fun Activities that Won’t Destroy Your Home or Classroom! (Future Horizons Inc., 2005). “We taught Geoffrey songs because Oliver seemed to like singing – Geoffrey noted that Oliver fluffed his feathers and would bob up and down, things my son thought were funny.”

Bonnie continues, “Geoffrey was led to learn the ‘ABC’ song, the ‘Wheels on the Bus,’ ‘Head and Shoulders, Knees and Toes’ and so on. Oliver didn't repeat the phrases, because he primarily could only say just a few things like ‘hello,’ ‘pretty bird,’ ‘Oliver,’ ‘bye, bye,’ but he did respond in physical ways that my son could visually see, unlike facial expressions, which were practically impossible for him to read.”

With his over-exaggerated body language – bobbing head, constant shuffling on his perch, cocked sideways stare, and puffing feathers – Oliver was able to engage Geoffrey’s mind at a point in his development when the subtleties of human communication couldn’t. Highly visual and personally amusing, Oliver presented Geoffrey with a first step in developing his communication skills, expanding his vocabulary, and gaining a rudimentary understanding of more complex human interactions.

Therapy Companions

Animal-assisted therapy routines have been used for several years to improve the physical, social, emotional, and cognitive functioning of patients who have become disconnected from human social interaction. Those who participate in animal-assisted therapy often report varying benefits including: comforting physical contact with animals, reduced loneliness, and, in group therapy sessions, increased opportunities for interacting with others.

In addition, caring for pets encourages a number of occupational skills and adherence to a daily schedule, such as walking or feeding the pet. This type of therapy is becoming increasingly important is areas of elderly care, focusing on the social and personal needs of senior citizens who require some form of assistance with their daily activities and health management. In particular, seniors who are struggling with dementia – in which memory, attention, and language skills become impaired – may benefit from a constant connection to daily routines in the form of animal care and companionship.

Cathleen Connell, PhD, associate director for the Center for Managing Chronic Disease at the Ann Arbor-based University of Michigan, has conducted a recent study examining the relationship between animals and senior citizens with dementia, and the affect this connection has on their condition. The study focused on a randomized selection of elderly women providing in-home care for a husband with dementia, who also owned either a cat or dog as a pet.

The study observed several positive responses that were common in both caregivers and care recipients. Many dementia patients formed a closer emotional bond with their pets, and the pet became a larger form of emotional support for both care recipients and caregivers. Several caregivers in the study mentioned that they acquired pets specifically for their husbands, believing they would provide a source of comfort and support while the caregiver was away.

Providing exercise and stress relief for both caregiver and care recipient, the pets were also observed to play a unique support role. For instance, pets can provide a dementia patient with nonverbal communication and constant interaction, whereas human socialization feels strained and may wax and wane with the patient’s mental status.

“Most therapy programs do not pair a dog with a person with dementia,” says Connell. “Instead, they offer people with dementia who reside in a care facility a chance to visit with a trained (often certified) therapy dog for a limited interaction. In that way, the training is significantly less intense and involves a screening for confident, patient, forgiving dogs that love people and can roll with the punches.”

In addition to her research, Connell utilizes her dog, Blue – a standard poodle trained as a therapy dog – to perform therapeutic services on rehabilitation, brain injury, and dementia patients. Although her specialty is older people with dementia, Connell has worked with patients of all ages and conditions. Blue has also been a visitor to a local elementary school, where interested children may choose to read a book to him. Unlike human interaction, Blue’s interest does not fade if the child struggles with a word or their pronunciation is incorrect – moreover, Blue will never correct them.

“From my experience, any well-trained dog – including mixed breeds – that is devoted to his/her therapy partner can provide animal-assisted therapy to people with dementia,” says Connell. “From time to time, a therapy recipient will have a preference for a lap dog or one that reminds them of a much loved pet from long ago, but most of the time, breed simply doesn’t matter.”

She continues, “Although some people with dementia are not particularly interested in visiting, others smile and are eager to pet or interact with a dog. Staff usually knows which patients will benefit most, and that is typically those who have strong and positive relationships with pets in their past.”

Hospital Hounds

In a similar approach, Elton Strauss, MD, chief of trauma and adult reconstructive surgery at Mount Sinai School of Medicine in New York City, has introduced his dog, Joey, a miniature Australian Labradoodle, as a support companion for recovering patients. Although most of Mount Sinai’s therapy dog programs focus on pediatric and rehabilitation patients, Strauss felt Joey’s training would be more appreciated among geriatric patients.

“Most of these patients just talk to her,” says Strauss. “I’ll ask them if they want to see Joey do a trick or two, and then I’ll say ‘Do you want to try to get Joey to sit down?’, ‘Do you want to get Joey to lie down?’, or ‘Do you want to ask Joey to speak?’”

Strauss continues, “Some of them will be very animated, and they’ll do everything. Some of them will just stare at her or touch her. I find that the biggest plus is the touching. Most geriatric patients are usually alone, and they don’t get to touch anybody else. They really find having someone in bed with them is a real treat.”

Introducing animals into a therapeutic environment, especially in a hospital, also brings in a need for strict policies regarding cleanliness and health concerns. Patients should wash their hands before and after a session to avoid cross-contamination. Every therapy program should have areas where the animal is not allowed to go, in case other clients have allergies or a fear of animals.

Specific cleaning and disinfecting procedures should be developed for equipment, treatment areas, and outside areas where urination or defecation occurs. Also, the animal involved in therapy should be routinely groomed and examined by a veterinarian.

Before recommending a patient to participate in animal-assisted therapy, therapists should consider the basic health concerns, including allergies, asthma, respiratory disorders, open wounds, burns, and other skin conditions. If left unsupervised or not discussed, a hidden allergy to pet dander could set off a chain reaction of negative physiologic responses that could actually inhibit therapy progress.

Also, the individual patient’s past experience with animals should also be noted. Some patients may be cynophobics – people who possess an irrational fear of dogs – an increasingly common condition, possibly due to the dog’s status as a domesticated predator, and also the increasing media coverage of dog attacks. Other patients may have a conditioned fear of dogs due to a past traumatic experience, such as being the victim of an animal attack or witnessing dog abuse. Careful patient screenings for these types of past experiences will assist therapists in deciding if animal-assisted therapy is suitable as an adjunct regimen for the patient.

“The first thing is that you have to ask the patient if they are interested in seeing the dog,” says Strauss. “We hate to just storm into the room and somebody gets fearful, or they are allergic to the dog. Then, I will ask them, ‘Would [you] like to pet the dog?’ And then I’ll ask them, ‘Would you like to give the dog a treat or two?’ And then I’d say, if everything is going well, ‘Do you have an interest in Joey sitting in bed with you?’, if they’re in bed. If they’re sitting in a chair, I’ll bring a chair next to them and put Joey on the chair, and then I kind of just let it happen.”

Strauss continues, “Either they’ll start a conversation with Joey, or they’ll just start touching her. I try to give them a good 15 [minutes] to 20 minutes of ‘Joey time’. The hardest part is that there are usually 10 to 12 patients that we see, so I don’t want to tire Joey out. Her attention span is usually about 10 [minutes] to15 minutes; I find that after that she gets a little itchy to leave.”

Across the Field

Although dogs top the list for the most popular species, other animals are utilized in therapy, depending on the comfort and preference of the individual.  For example, therapists working with individuals afflicted with autism spectrum disorders, Down syndrome, and other developmental disorders find that these patients respond best to animal-assisted therapy using horses. The motion of the horse, concentration needed to acquire riding skills, and the communication between instructor and rider benefit many patients.

In other areas, many nursing homes are investing in “bird rooms”, where a few canaries or doves are kept for the viewing and listening pleasure of the residents. Some residents are encouraged to assist in caring for the birds, emphasizing a personal connection that disperses feelings of loneliness, boredom, and helplessness – a cocktail of symptoms that leads to depression and withdrawal from human interaction.

Likewise, scheduled therapy sessions with cats and rabbits have been similarly used in hospitals and hospice facilities in attempts to reconnect with patients using this stimulus.

Studies continue to expand on the usage of animal-assisted therapy as an adjunct to physical therapy, motivating patients to re-establish cognitive and sensory links with this external interaction. As the motion, feel, smell, sound, and sight of an animal transcends the necessity for human verbal interaction, therapists hope that animal-assisted therapy may eventually aid in rebuilding cognitive awareness of both the elderly and developmentally challenged patients.
   
    — Bob Stott is a staff writer for Therapy Times. Questions and
comments can be directed to bstott@therapytimes.com.