Animal-assisted therapy for patients in a minimally conscious state: A randomized two treatment multi-period crossover trial

Abstract

ObjectiveTo investigate if animal-assisted therapy (AAT) leads to higher consciousness in patients in a minimally conscious state during a therapy session, measured via behavioral reactions, heart rate and heart rate variability.MethodsIn a randomized two treatment multi-period crossover trial, 10 patients in a minimally conscious state participated in eight AAT sessions and eight paralleled conventional therapy sessions, leading to 78 AAT and 73 analyzed control sessions. Patients’ responses during sessions were assessed via behavioral video coding and the Basler Vegetative State Assessment (BAVESTA), heart rate and heart rate variability (SDNN, RMSSD, HF and LF). Data were analyzed with generalized linear mixed models.ResultsPatients showed more eye movements (IRR = 1.31, 95% CI: 1.23 to 1.40, p < 0.001) and active movements per tactile input during AAT compared to control sessions (IRR = 1.13, 95% CI: 1.02 to 1.25, p = 0.018). No difference was found for positive emotions. With BAVESTA, patients’ overall behavioral reactions were rated higher during AAT (b = 0.11, 95% CI: 0.01 to 0.22, p = 0.038). AAT led to significantly higher LF (b = 5.82, 95% CI: 0.55 to 11.08, p = 0.031) and lower HF (b = -5.80, 95% CI: -11.06 to -0.57, p = 0.030), while heart rate, SDNN, RMSSD did not differ.ConclusionsPatients in a minimally conscious state showed more behavioral reactions and increased physiological arousal during AAT compared to control sessions. This might indicate increased consciousness during therapeutic sessions in the presence of an animal.Trial registrationClinicalTrials.gov NCT02629302.

Influences of Animal-Assisted Therapy on Episodic Memory in Patients with Acquired Brain Injuries

“…This effect is probably driven by a stronger encoding and is found for both positive and negative emotions [ 10 ]. It was shown that memory is especially enhanced by emotions driven by stimuli that have a high emotional relevance for us [ 11 , 12 , 13 , 14 ]. Humans develop close emotional bonds and relevant social relationships with animals [ 15 , 16 ].…”

“…Research shows that AAT can lead to enhanced social behaviour, positive emotions and therapy motivation in patients with acquired brain injury [ 20 ]. In patients in a minimally conscious state, the presence of an animal can lead to more behavioural reactions and increased physiological arousal compared to control sessions [ 14 ]. However, there are no studies investigating long-term effects of AAT on memory in patients with acquired brain injuries.…”

“…The aim of this pilot study was to investigate long-term effects of AAT on episodic memory in patients with acquired brain injury who participated in a precursor study two years ago [ 14 ]. We hypothesized that patients remember therapy sessions in the presence of an animal better after two years than comparable standard therapy sessions and that this effect might be driven by increased positive emotions in the presence of an animal.…”

Dog-Assisted Therapy in Neurorehabilitation of Children with Severe Neurological Impairment: An Explorative Study

“…4,6,[17][18][19][20] A first study on animal-assisted therapy on patients in minimally conscious state found increased behavioral reactions and physiological arousal during animalassisted therapy sessions compared with control therapy sessions. 21 Apart from this study, only anecdotal data exist regarding animal-assisted therapy for patients with severe neurological illnesses like disorders of consciousness. 22,23 There is a lack of research investigating for which patients with severe neurological impairments animal-assisted therapy might be an option, how the therapy should be conducted, or what effects this therapy form might have.…”

Is Animal-Assisted Therapy for Minimally Conscious State Beneficial? A Case Study

“…This illustrates why animals are seen as helpful partners within therapy for patients with disorders of consciousness. In a first controlled study, Hediger and colleagues showed beneficial effects of AAT in patients in a MCS compared to control therapy sessions (11). Beside such quantitative research on this topic it is crucial to learn for what patients AAT could be a promising approach and understand the individual reactions of patients.…”