Animal-Assisted Therapy for children in rehabilitation By Emilee Hodge

Target Population Pediatric patients in rehabilitation Each year more than 3 million children are hospitalized in the U.S. Traumatic accident Brain injury Spinal cord injury Stroke Etc. Illness Cancer Post surgery, pediatric patients can experience copious amounts of stress which may lead to negative physiological and psychological secondary deficits. https://www.allegiancehealth.org/sites/default/files/styles/center_column/public/pediatric-unit.jpg?itok=acWSEQHd

Purpose Animal-assisted therapy can show much improvement in: Stress levels Vital signs Reduced pain Rapid recovery By introducing pediatric patients to animal-assisted therapy, they will be allowed to reduce the stress they are experiencing due to the surgical procedure - by reducing the clients stress, it may also allow for reduction of pain experienced and also promote a faster recovery process. https://wp0.its.vanderbilt.edu/vanderbiltnurse/wp-content/uploads/sites/70/feature-1-copy.jpg

Intervention POOCH (Pets Offer Ongoing Care and Healing) program Participants in the POOCH program will be matched with a therapy dog pre-surgery, and then will be interacting with their assigned therapy dog post surgery in order to meet their needs and goals The goals for each patient will be tailored to him or her according to their needs. In this particular treatment intervention POOCH therapy dogs will be assigned to patients who: are experiencing copious amounts of stress because of their surgery will be required to improve upon fine and gross motor skills post-surgery. This intervention group will consist of 5 patients each patient will have their own recreational therapist to help them in a 1:1 setting. The therapy dog will be interacting with patients for 45-minutes each session for a 5 week recovery period participating with their patient in a variety of activities that promote stress reduction and improved fine and gross motor skills.

Recreational Therapist Staff requirements Recreational Therapist Therapy Dog The recreational therapist to patient ratio for the POOCH program will be 5:5 each session The recreational therapist must: be certified or licensed in recreational therapy and certified in CPR have no pet allergies have experience working with the POOCH program for at least 6 months; or has been trained by an experienced recreational therapist working with the POOCH program for the past year. The therapy dog must: be a licensed therapy dog that has been involved in the POOCH program for at least 6 months must also be able to detect signs of stress or pain in pediatric patients must be able to ride elevators and be calm around assistive devices such as walkers or wheelchairs cannot be sensitive to loud noises such as crying or screaming Must be in good physical health with yearly veterinary health checks

Methods Once the client has enrolled in the POOCH program at Carolinas Rehabilitation Hospital, here is a step by step outline of what the client can expect:   1-Week Prior to Surgery - Once the therapy dog has been assigned to the patient, they will get to meet their assigned therapy dog at least 1-week prior to their expected date for surgery. This will give the client a chance to get comfortable with their therapy dog and learn specific things they need to know about having a therapy dog. https://www.flickr.com/photos/childrensla/sets/72157625067874138/

Methods – Week 1 Week 1 (post-surgery) The Tuesday after the client has completed their surgery they will begin participating in the POOCH program. This week will be focused around relieving post-surgery anxiety and stress Tuesday – Free Time - During this session the client will still be in the early stages of recovery and may not have much mobility due to pain. Because of this, the client will have a full session of free time with their therapy dog. During this 45 minutes session the client will choose what they would like to do. Anticipated requests may include snuggling with their therapy dog, watching TV with their therapy dog, or just talking to and petting their therapy dog. Thursday – Draw a Picture - During this session the client will get to spend more time with their therapy dog but will also be required to color or draw a picture of their therapy dog to hang inside their hospital room. When the client completes their picture, they may spend the remaining time having free time with their therapy dog.

Methods – week 2 Week 2 – Fine Motor During the 2nd week of the POOCH program, the client will be focused on improving their fine motor skills. Tuesday – Giving Treats - During this session the client will work on their fine motor skills by getting to give the therapy dog treats. First the recreational therapist will help the client learn the different commands their therapy dog responds to and they will practice giving the commands to the therapy dog. Once the client is comfortable giving the dog different commands, they will start giving the dog commands with no help from the recreational therapist. After each command, the client will open the bucket of treats, grab a treat, close the treat bucket, and feed it to the therapy dog. After each command the client will repeat these steps. After completing this activity, for the last 15 minutes of the session the client will have free time with their therapy dog. Thursday – Giving Treats and Putting on Collar & Leash - During the first 10 minutes of this session the client will practice giving commands to the therapy dog and giving it treats. For the next 20 minutes, the client will practice putting a collar and a leash on the therapy dog. The client will be required to put the collar around the dog’s neck and buckle the collar together. The client will then be required to clip the leash onto the collar. This activity will be repeated several times, or until the 20 minutes is up. For the last 15 minutes the client will have free time with the therapy dog.

Methods – week 3 Week 3 – Fine and Gross Motor During the second week of the POOCH program, the client will be perfecting their fine motor skills while also starting to work on gross motor skills. Tuesday – Treats, Collar & Leash, Walking 1 Lap - The client will begin this session by giving the therapy dog three commands of their choosing and giving the therapy dog a treat using the skills learned in the previous weeks. Next, the client will put the collar and leash on the dog. If the client does not complete this activity correctly and independently the first time, they will do the activity again until they get the collar and the leash on the dog correctly. Next, the client will walk the dog around the facility with the leash 1 round. The recreational therapist will have to assist the client in holding the leash if they are using any assistive ambulation devices. For the remainder of the time the client will have free time with the therapy dog. Thursday – Treats, Collar & Leash, Walking - The client will begin this session by giving the therapy dog three commands of their choosing and giving the therapy dog a treat using the skills learned in the previous weeks. Next, the client will put the collar and leash on the dog. If the client does not complete this activity correctly and independently the first time, they will do the activity again until they get the collar and the leash on the dog correctly. For the remainder of the time the client will make rounds around the hospital walking the dog.

Methods – week 4 Week 4 – Fine and Gross Motor During the fourth week of the POOCH program, the client will continue working on and perfecting their fine and gross motor skills. Tuesday – Treats, Collar & Leash, Walking with Group - The client will begin this session by giving the therapy dog three commands of their choosing and giving the therapy dog a treat using the skills learned in the previous weeks. Next, the client will put the collar and leash on the dog. For the remainder of the time the client will make rounds around the hospital, with other group members, walking their therapy dog. Thursday – Treats, Grooming - The client will begin this session by giving the therapy dog three commands of their choosing and giving the therapy dog a treat using the skills learned in the previous weeks. The recreational therapist will then show the client how to groom the therapy dog with a brush. The client will then take time grooming the dog (brushing its back only) alternating brushing with both arms and crossing midline. For the last 15 minutes of the session the client will have free time with the therapy dog.

Methods – week 5 Week 5 – Fine and Gross Motor - During the last week of the POOCH program the client will continue perfecting skills learned in the previous week and will then demonstrate competency of those skills. Tuesday – Grooming, Leash & Collar, Playing Catch - The client will begin this session by grooming the therapy dog for 15 minutes, alternating between both arms and crossing midline. The client will then put the leash and collar on the dog and make two rounds around the hospital walking the therapy dog. The client will then walk the dog to the open room and will throw or roll the ball to the dog. The dog will bring the ball back to the client and they will continue those steps for the remainder of the session. Thursday – Demonstrate Competence in Skills Learned - For the last treatment session, the client will give one command and treat to the therapy dog, the client will then demonstrate competence in grooming the dog using both arms and crossing midline. The client will then show competence in putting the collar and leash on the dog and will walk the dog to the open room. Next the client will play fetch with the therapy dog. For the last 15 minutes of the session, if time allows, the client will have free time with the therapy dog.

Client outcomes – Goal 1 Goal 1: To reduce anxiety and stress During treatment session, client will draw and color a picture of their therapy dog in order to decrease anxiety and stress. For the last 15 minutes of the treatment session, client will pick one activity to engage in during free time, and will engage in that activity with their therapy animal, in order to decrease anxiety and stress. At the end of the treatment intervention, client will participate in post-stress and anxiety test, in order to show reduced anxiety and stress over the course of the program https://www.abclawcenters.com/blog/2013/10/16/animal-therapy-can-provide-enormous-135088/

Client outcomes – goal 2 Goal 2: To increase fine motor skills During treatment session, client will feed the dog 3 treats after 3 different commands with minimal assistance, in order to improve fine motor skills. During treatment session client will buckle collar around the dogs neck with minimal assistance from recreational therapist in order to improve fine motor skills. During treatment session client will clip leash to the dogs collar with minimal assistance from recreational therapist in order to improve fine motor skills.

Client outcomes – goal 3 Goal 3: To increase gross motor skills During treatment session client will walk dog around hospital at least 3 different rounds with minimal assistance from recreational therapist in order to improve gross motor skills. During treatment session client will cross midline at least 3 times while brushing dog with minimal assistance from recreational therapist, to increase gross motor skills. During treatment session client will alternate arms at least 3 times while brushing dog with minimal assistance from recreational therapist, to increase gross motor skills. During treatment session client will throw or roll ball at least 15 ft. with minimal assistance from recreational therapist in order to increase gross motor skills.

References Calcaterra, V., Veggiotti, P., Palestrini, C., De Giorgis, V., Raschetti, R., Tumminelli, M., & ... Pelizzo, G. (2015). Post- operative benefits of animal-assisted therapy in pediatric surgery: a randomised study. Plos One, 10(6), e0125813. doi:10.1371/journal.pone.0125813 Chia-Chun, T., Friedmann, E., & Thomas, S. A. (2010). The Effect of Animal-Assisted Therapy on Stress Responses in Hospitalized Children. Anthrozoos, 23(3), 245-258. doi:10.2752/175303710X12750451258977 Horowitz, S. (2010). Animal-assisted therapy for inpatients: tapping the unique healing power of the human- animal bond. Alternative & Complementary Therapies, 16(6), 339-343. doi:10.1089/act.2010.16603 Marcus, D. A. (2013). The science behind animal-assisted therapy. Current Pain And Headache Reports, 17(4), 322. doi:10.1007/s11916-013-0322-2 Tielsch Goddard, A., & Gilmer, M. J. (2015). The Role and Impact of Animals with Pediatric Patients. Pediatric Nursing, 41(2), 65-71. Urbanski, B. L., & Lazenby, M. (2012). Distress Among Hospitalized Pediatric Cancer Patients Modified By Pet-Therapy Intervention to Improve Quality of Life. Journal Of Pediatric Oncology Nursing, 29(5), 272-282. doi:10.1177/1043454212455697