Inpatient Physical Activity Function Through Enhanced Participation Levels in Animal-Assisted Therapy Programs

Many medical care facilities in the United States employ therapy dogs in Animal Assisted
Interventions (AAI), which can be categorized as either Animal Assisted Activities (AAA) or
Animal Assisted Therapy (AAT). AAA programs are more casual and are typically not
goal-oriented, instead tending to focus on human-animal engagement. AAT programs are formal
interventions targeting specific therapeutic goals using defined therapy sessions with a
physical, psychological, occupational, or speech therapist. AAT programs with Physical
Therapists focus on patients with motor deficits, such as those hospitalized due to stroke
(14.5-16.1% lifetime incidence), Parkinson's (1.3-2% lifetime incidence), or other
neurological injuries/disorders.

In the last decade, the popularity of AAT programs in hospitals has significantly increased,
and there has been tremendous growth in the number of studies assessing whether the use of
canine AAA or AAT have positive medical impacts on patients. Currently, the majority of
studies focus on AAA programs, possibly because AAT programs require formally trained
therapists and animals, program consistency, and strict program structure. Unfortunately,
while most studies suggest that use of AAT can improve patient outcomes, many are poorly
designed, poorly described, and few include randomized, controlled trials (RCT). The few
existing RCT AAT studies focus on depression, schizophrenia, or other psychiatric disorders
and suggest improvements in depression, anxiety, self-esteem, social outcomes, and
enjoyment/pleasure. No RCT studies have looked at AAT in a physical therapy setting.
However, non-controlled, non-randomized studies suggest that AAT as part of physical therapy
may improve patient physical outcomes (such as walking speed, number of steps, gait, etc.),
possibly by impacting patient motivation and participation in physical therapy activities.

The Aurora Sinai Medical Center (ASMC) currently utilizes both AAA and AAT programs. Most
patients involved in the AAT program at ASMC are undergoing intensive inpatient physical
therapy due to stroke, Parkinson's disease, or other diseases causing generalized weakness
deconditioning, and these inpatients receive daily physical therapy with the occasional
opportunity to include AAT in their therapy sessions. Previous studies suggest that patient
interactions with therapy dogs are intrinsically rewarding, suggesting that use of an AAT
program may increase patient motivation to participate and thus improve physical indices.
However, this has yet to be objectively analyzed.

Hypothesis: Canine AAT in inpatient physical therapy improves physical activity function
through enhanced levels of participation in physical therapy sessions.

Specific Aim 1: To evaluate whether patient participation increases during physical therapy
using canine AAT. Physical activity function is impacted by a patient's level of
participation, which is influenced by multiple sub-factors. Participation can be measured in
multiple ways, including subjectively by the patient, subjectively by an observer (the
physical therapist), or objectively through activity outputs. The level of participation may
or may not correlate with the patient's self-perceived motivation.

Specific Aim 2. To determine whether use of canine AAT increases patient enjoyment and
motivation in physical therapy. Many people perceive interactions with animals as
intrinsically motivating and enjoyable. Consistent with this, canine AAT can improve patient
motivation to participate in physical therapy. However, neither enjoyment nor motivation
have been studied in physical therapy rehabilitation inpatients, nor have they been tested
in RCT settings.

Specific Aim 3: To assess whether patient perceptions of care improve with use of canine AAT
in physical therapy. Because the presence of a therapy canine may improve mood, motivation,
and/or patient/caregiver communications, we hypothesize that use of canine AAT in inpatient
physical therapy will improve patient perceptions of their caregivers, their care, and the
hospital.

Innovation and Impact While AAT programs are currently used throughout the United States in
inpatient rehabilitation programs, it is unknown whether and how these programs impact
patient physical activity functions. This study will elucidate whether these programs
provide benefits to patients or medical institutions, thereby providing medical providers
with the data necessary to choose the most effective and impactful care for their patients.

Inclusion Criteria:

1. Are being rehabilitated as an inpatient for Parkinson's, stroke, or generalized
weakness deconditioning (muscle weakness);

2. Are able to give informed consent or communicate either verbally or in writing;

3. Are able to follow instructions;

4. Are at least 18 years old; and

5. Choose to participate.

Exclusion Criteria:

1. Have a fear/dislike of dogs;

2. Show noticeable cues of resistance/discomfort to dogs;

3. Are allergic to dogs;

4. Are immunocompromised;

5. Are not being rehabilitated for Parkinson's, stroke, or generalized weakness
deconditioning (muscle weakness);

6. Are not able to give informed consent or communicate either verbally or in writing;

7. Are not able to follow instructions;

8. Do not speak English;

9. Are not at least 18 years old; and

10. Do not choose to participate.