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A Patient's Best Friend

Dogs assist in recovery of kids, adults at Virginia, D.C. facilities

Monday November 3, 2008
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Kids and dogs nurses find this natural pairing promotes healing and motivates children to work harder in therapy.

"There is a therapeutic value," says Leslie Horton, RN, animal-assisted care program coordinator at Inova Fairfax Hospital in Falls Church, Va. "I have seen so many patients respond who haven't responded to family or anyone else. We bring a dog in and they jump three or four levels on the Rancho [brain injury recovery] scale."

Horton pioneered Inova Fairfax's multifaceted program about eight years ago. The program and Horton have won first-place Beyond Limits awards twice from the Delta Society. The nonprofit organization's award is dedicated to promoting human health and well-being through interactions with companion animals and recognizes outstanding work in the field of the human-animal bond.

Children's National Medical Center in Washington, D.C., offers a pet visitation program. The dogs primarily interact with children who are there for prolonged stays.

"You can see a mood change, a smile on a face," says Audrey Scully, RN, BSN, CPN, clinic coordinator in the neurology department at Children's.

Reaching Autistic Children
In January 2007, Children's started an animal-assisted therapy program, primarily for autistic children working on augmentative and alternative communication skills in the department of hearing and speech within the Neuroscience Center of Excellence.

"The dog is a motivational tool," Scully says. "[Children with autism] engage with the dog to learn how to communicate."

The therapy dogs help the children by responding to the command youngsters give using an electronic communication board. For instance, if the child touches a picture of a dog sitting, the device says, "sit" and the dog responds appropriately. Other images might depict the dog eating, lying down, or standing, and the canine calmly does whatever it is told.

"It's an automatic response for the child," Scully says. "The child learns there is positive feedback. ... It tells the child, 'What I say works.' "

Two children with sensory aversions have learned to pet the dogs. They also have become more engaged at home and are willing to do more with their families, Scully says.

Dogs also work with autistic children at Inova Fairfax. Therapists may have the child throw a ball to the dog, walk with it, or use the dog to help develop communication skills.

"Children respond better with the animal there," Horton says. "They remain more focused."

Horton says she has not had an autistic child act out toward a dog but acknowledges it is possible. However, she adds, sometimes the child's impulse control is not as good as it should be, and petting becomes rough.

"The dogs don't seem to care, but we encourage children to go a little softer," Horton says. "Most parents believe the interaction has made a difference in their child's behavior."

Dramatic Outcomes
Weeks after neurosurgery, a young boy at Inova Fairfax had taken only a few steps. The inability to ambulate kept him hospitalized. The team decided to try letting him walk with a dog.

"He was able to walk, but he didn't want to go farther," Horton says. "He got so busy walking the dog, he didn't realize how far he had walked. He was discharged the next day."

Canines sometimes seem to work miracles. Horton recalled bringing a dog to meet a 16-year-old boy, comatose after a head injury. The boy responded to pain stimuli but nothing else.

"We put the dog on the bed, and he woke up and was able to wave to his mother at the foot of the bed," Horton says.

In another case, physicians never expected a teenage girl to emerge from a coma suffered in a car accident. The girl responded slightly when Horton brought the dog in, offering some hope. Horton and her dog continued to visit as the girl improved. Eventually, the patient transferred to a rehabilitation center.

Establishing a Program
Some facilities have established rules for their animal-assistance programs. Dogs must receive formal registration or certification through an official therapy organization. Before that can occur, the canines must meet temperament and obedience standards. Handlers keep the canines current on their vaccinations, and a veterinarian deems them to be in good health.

Physicians at Inova Fairfax must give an order for animal interventions, and parents must approve of the canine interactions. Some people are fearful or worry about infections. To prevent infection, patients wash their hands before and after the dog encounter, and if the dog gets up on the bed, it lies on a sheet barrier. Horton tracks infection rates, and Inova Fairfax has not had one nosocomial case attributed to a dog visit.

While many nurses recognize the role dogs play in promoting health, too many healthcare providers remain unaware of an animal's tremendous healing potential, according to the Delta Society.

"People need to understand this field is growing and to be receptive," Horton says. "They need to be aware of the therapeutic value and think outside of the box."

Debra Anscombe Wood, RN, is a freelance writer.

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