Post-operative benefits of animal-assisted therapy in pediatric surgery: a randomised study

Valeria Calcaterra, Pierangelo Veggiotti, Clara Palestrini, Valentina De Giorgis, Roberto Raschetti, Massimiliano Tumminelli, Simonetta Mencherini, Francesca Papotti, Catherine Klersy, Riccardo Albertini, Selene Ostuni, Gloria Pelizzo, Valeria Calcaterra, Pierangelo Veggiotti, Clara Palestrini, Valentina De Giorgis, Roberto Raschetti, Massimiliano Tumminelli, Simonetta Mencherini, Francesca Papotti, Catherine Klersy, Riccardo Albertini, Selene Ostuni, Gloria Pelizzo

Abstract

Background: Interest in animal-assisted therapy has been fuelled by studies supporting the many health benefits. The purpose of this study was to better understand the impact of an animal-assisted therapy program on children response to stress and pain in the immediate post-surgical period.

Patients and methods: Forty children (3-17 years) were enrolled in the randomised open-label, controlled, pilot study. Patients were randomly assigned to the animal-assisted therapy-group (n = 20, who underwent a 20 min session with an animal-assisted therapy dog, after surgery) or the standard-group (n = 20, standard postoperative care). The study variables were determined in each patient, independently of the assigned group, by a researcher unblinded to the patient's group. The outcomes of the study were to define the neurological, cardiovascular and endocrinological impact of animal-assisted therapy in response to stress and pain. Electroencephalogram activity, heart rate, blood pressure, oxygen saturation, cerebral prefrontal oxygenation, salivary cortisol levels and the faces pain scale were considered as outcome measures.

Results: After entrance of the dog faster electroencephalogram diffuse beta-activity (> 14 Hz) was reported in all children of the animal-assisted therapy group; in the standard-group no beta-activity was recorded (100% vs 0%, p<0.001). During observation, some differences in the time profile between groups were observed for heart rate (test for interaction p = 0.018), oxygen saturation (test for interaction p = 0.06) and cerebral oxygenation (test for interaction p = 0.09). Systolic and diastolic blood pressure were influenced by animal-assisted therapy, though a higher variability in diastolic pressure was observed. Salivary cortisol levels did not show different behaviours over time between groups (p=0.70). Lower pain perception was noted in the animal-assisted group in comparison with the standard-group (p = 0.01).

Conclusion: Animal-assisted therapy facilitated rapid recovery in vigilance and activity after anaesthesia, modified pain perception and induced emotional prefrontal responses. An adaptative cardiovascular response was also present.

Trial registration: ClinicalTrials.gov NCT02284100.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow diagram of the progress…
Fig 1. Flow diagram of the progress through the phases of the randomised trial of two groups (animal-assisted therapy and standard care after surgery).
Fig 2. Comparison of the model-derived profiles…
Fig 2. Comparison of the model-derived profiles for heart rate (HR), diastolic blood pressure (DBP), oxygen saturation (SpO2), cerebral prefrontal oxygenation (HbO2) in animal-assisted therapy (AAT) and standard (STAND) groups.
All models are adjusted for time of anesthesia

References

    1. Miller J, Connor K Going to the dogs…for help. Nursing 2003;30: 65–67.
    1. Wohlfarth R, Mutschler B, Beetz A, Kreuser F, Korsten-Reck U. Dogs motivate obese children for physical activity: key elements of a motivational theory of animal-assisted interventions. Front Psychol. 2013;4: 796 10.3389/fpsyg.2013.00796
    1. Kamioka H, Okada S, Tsutani K, Park H, Okuizumi H, Handa S, et al. Effectiveness of animal-assisted therapy: A systematic review of randomized controlled trials. Complement Ther Med. 2014; 22: 371–390. 10.1016/j.ctim.2013.12.016
    1. Barker SB, Dawson KS. The effects of animal-assisted therapy on anxiety ratings of hospitalized psychiatric patients. Psychiatr Serv. 1998;49: 797–801.
    1. Barker SB, Knisely JS, McCain NL, Best AM. Measuring stress and immune response in healthcare professionals following interaction with a therapy dog: a pilot study. Psychol Rep. 2005;96: 713–729.
    1. Barker SB, Pandurangi AK, Best AM. Effects of animal-assisted therapy on patients' anxiety, fear, and depression before ECT. J ECT 2003;19: 38–44.
    1. Barker SB, Wolen AR. The benefits of human-companion animal interaction: a review. J Vet Med Educ. 2008;35: 487–495. 10.3138/jvme.35.4.487
    1. Bardill N, Hutchinson S. Animal-assisted therapy with hospitalized adolescents. J Child Adolesc Psychiatr Nurs. 1997;10: 17–24.
    1. Richeson NE. Effects of animal-assisted therapy on agitated behaviors and social interactions of older adults with dementia. Am J Alzheimers Dis Other Demen. 2003;18: 353–358.
    1. O'Haire ME. Animal-assisted intervention for autism spectrum disorder: a systematic literature review. J Autism Dev Disord. 2013; 43: 1606–1622. 10.1007/s10803-012-1707-5
    1. Banks MR, Banks WA. The effects of animal-assisted therapy on loneliness in an elderly population in long-term care facilities. J Gerontol A Biol Sci Med Sci. 2002;57: M428–32.
    1. Banks MR, Willoughby LM, Banks WA. Animal-assisted therapy and loneliness in nursing homes: use of robotic versus living dogs. J Am Med Dir Assoc. 2008;9: 173–177. 10.1016/j.jamda.2007.11.007
    1. Barba BE. The positive influence of animals: animal-assisted therapy in acute care. Clin Nurse Spec. 1995;9: 199–202.
    1. Cole KM, Gawlinski A. Animal-assisted therapy: the human-animal bond. AACN Clin Issues. 2000,11: 139–149.
    1. Beetz A, Julius H, Turner D, Kotrschal K. Effects of social support by a dog on stress modulation in male children with insecure attachment. Front Psychol. 2012; 3:352 10.3389/fpsyg.2012.00352
    1. Beetz A, Uvnäs-Moberg K, Julius H, Kotrschal K. Psychosocial and psychophysiological effects of human-animal interactions: the possible role of oxytocin. Front Psychol. 2012; 3:234 10.3389/fpsyg.2012.00234
    1. Berry A, Borgi M, Francia N, Alleva E, Cirulli F. Use of assistance and therapy dogs for children with autism spectrum disorders: a critical review of the current evidence. J Altern Complement Med. 2013;19: 73–80. 10.1089/acm.2011.0835
    1. Martin F, Farnum J. Animal-assisted therapy for children with pervasive developmental disorders. West J Nurs Res. 2002;24: 657–670.
    1. Braun C, Stangler T, Narveson J, Pettingell S. Animal-assisted therapy as a pain relief intervention for children. Complement Ther Clin Pract. 2009;15: 105–109. 10.1016/j.ctcp.2009.02.008
    1. Kinner VL, Het S, Wolf OT. Emotion regulation: exploring the impact of stress and sex Front Behav Neurosci. 2014;8: 397 10.3389/fnbeh.2014.00397
    1. Kim MK, Kim M, Oh E, Kim SP. A review on the computational methods for emotional state estimation from the human EEG. Comput Math Methods Med. 2013: 573734.
    1. Makovac E, Garfinkel S, Bassi A, Basile B, Macaluso E, Cercignani M, et al. Effect of Parasympathetic Stimulation on Brain Activity During Appraisal of Fearful Expressions. Neuropsychopharmacology. 2015;Jan 12. 10.1038/npp.2015.10 [Epub ahead of print]
    1. Spiga F, Walker JJ, Terry JR, Lightman SL. HPA Axis-Rhythms. Compr Physiol. 2014;4: 1273–1298. 10.1002/cphy.c140003
    1. Bekkedal MY, Rossi J 3rd, Panksepp. Human brain EEG indices of emotions: delineating responses to affective vocalizations by measuring frontal theta event-related synchronization.Neurosci Biobehav Rev. 2011;35: 1959–1970. 10.1016/j.neubiorev.2011.05.001
    1. Harmon-Jones E, Winkielman P. Asymmetrical frontal cortical activity, affective valence, and motivational direction In: Guilford Press editor. Social Neuroscience; New York; 2007. pp. 137–156.
    1. Herrmann MJ, Ehlis AC, Fallgatter AJ. Prefrontal activation through task requirements of emotional induction measured with NIRS. Biol Psychol. 2003;64:2 55–263.
    1. Jausovec N, Jausovec K, Gerlic I. Differences in event-related and induced EEG patterns in the theta and alpha frequency bands related to human emotional intelligence. Neurosci. Lett. 2001;311: 93–96.
    1. Ernst LS. Animal-assisted therapy: paws with a cause. Nurs Manage. 2013;44: 16–19. 10.1097/01.NUMA.0000437777.22972.d1
    1. Ernst LS. Animal-assisted therapy: using animals to promote healing. Nursing. 2012;42: 54–58. 10.1097/01.NURSE.0000415837.20995.e2
    1. Fisher A, Wagner R, Newsome JT. Pet-assisted therapy. Lab Anim (NY). 2014;43: 122–123.
    1. Hooker SD, Freeman LH, Stewart P. Pet therapy research: a historical review. Holist Nurs Pract. 2002;16: 17–23.
    1. Kaldy J. Alternative therapies for a new era of health care. Consult Pharm. 2013;28: 84–90. 10.4140/TCP.n.2013.84
    1. Marcus DA. The science behind animal-assisted therapy. Curr Pain Headache Rep. 2013;17: 322 10.1007/s11916-013-0322-2
    1. Murphy M, Bruno MA, Riedner BA, Boveroux P, Noirhomme Q, Landsness EC, et al. Propofol anesthesia and sleep: a high-density EEG study. Sleep. 2011;34: 283–291.
    1. Ní Mhuircheartaigh R, Warnaby C, Rogers R, Jbabdi S, Tracey I. Slow-wave activity saturation and thalamocortical isolation during propofol anesthesia in humans. Sci Transl Med. 2013;5: 208ra148.
    1. Corazza I, Barletta G, Guaraldi P, Cecere A, Calandra-Buonaura G, Altini E, et al. A new integrated instrumental approach to autonomic nervous system assessment. Comput Methods Programs Biomed. 2014;11: 267–277
    1. Moghmi S, Kushki A, Guerguerian AM, Chau T. Characterizing emotional response to music in the prefrontal cortex using near infrared spectroscopy. Neurosci Lett. 2012;525: 7–11 10.1016/j.neulet.2012.07.009
    1. Woodside DB, Winter K, Fisman S. Salivary cortisol in children: correlations with serum values and effect of psychotropic drug administration. Can J Psychiatry.1991;36: 746–748.
    1. Viau R, Arsenault-Lapierre G, Fecteau S, Champagne N, Walker CD, Lupien S. Effect service dogs on salivary cortisol secretion in autistic children. Psychoneuroendocrinology 2010;35: 1187–93. 10.1016/j.psyneuen.2010.02.004

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe