Human-animal interaction to promote recovery following pediatric brain injury

摘要 在住院康复病房接受治疗的获得性脑损伤(ABI)儿童有很大的风险 长期功能损害，强调最大限度地发挥 住院康复治疗。拟议的试点试验旨在探索动物辅助治疗的价值 (AAT)在儿童获得性脑损伤后住院康复期间。为了实现这一目标，我们 将采用受试者内部交叉试验；所有参与者将有一只志愿者狗参与50%的 为期两周的物理治疗(PT)和职业治疗(OT)疗程。我们将招聘40人 年龄在6-17岁之间的患者在CCHMC的住院康复单元接受ABI治疗。AAT将 包括在PT和OT课程中整合来自医院的一只狗的志愿者狗计划，而非 AAT情况将由患者治疗小组确定为照常治疗(TAU)。我们已经订婚了 一支高素质的多学科团队，确保方法的安全性、可行性和有效性。我们 将实现以下目标：1)检查AAT对患者参与程度、患者情绪、 以及PT和OT期间的生理窘迫，以及2)探讨AAT对功能的影响 使用历史队列比较组的结果。作为一个探索性的目标，我们将研究一些 变量(伤害类型/严重程度、儿童性别和拟人化、治疗师因素和训犬员因素) 开始确定哪些患者在ABI住院康复期间最有可能受益于AAT，以及 潜在的作用机制。来自患者、家属和护理提供者(治疗师、 医疗队和训犬员)将在他们参与试验结束后被收集起来 确定干预的可行性和满意度，以及潜在的障碍和领域 进步。我们假设，在PT和OT会话中使用ATT将与 更多的患者参与，更多的积极情绪，以及更低的生理痛苦水平 陶先生。此外，预计研究样本将在功能上有更大的改善 结果比历史队列对照组要好。研究结果将为AAT的效用提供证据 用于ABI的住院康复，并有潜力提供信息和改善临床护理。如果成功，这将是 Pilot将为为难以接触的人群转变康复干预措施奠定基础 存在严重的长期功能性赤字的风险。

Abstract Children with acquired brain injuries (ABI) treated on an inpatient rehabilitation unit are at significant risk for long term functional impairment, highlighting the importance of maximizing the effectiveness and utilization of inpatient rehabilitation therapies. The proposed pilot trial seeks to explore the value of animal-assisted therapy (AAT) during inpatient rehabilitation following pediatric acquired brain injury. To accomplish this objective, we will employ a within subjects cross-over trial; all participants will have a volunteer dog involved in 50% of their physical therapy (PT) and occupational therapy (OT) sessions over a 2-week study period. We will recruit 40 patients between the ages of 6-17 being treated for ABI on the inpatient rehabilitation unit at CCHMC. AAT will consist of integration of a dog from the hospital volunteer dog program in PT and OT sessions, while the non- AAT condition will be treatment as usual (TAU) as identified by the patients' treatment team. We have engaged a highly qualified multidisciplinary team to ensure the safety, feasibility, and effectiveness of the methods. We will accomplish the following aims 1) Examine the effect of AAT on level of patient participation, patient affect, and physiological distress during PT and OT sessions, and 2) Explore the effect of AAT on functional outcomes using a historic cohort comparison group. As an exploratory aim, we will examine a number of variables (injury type/severity, child sex and anthropomorphism, therapist factors, and dog handler factors) to begin to determine which patients are most likely to benefit from AAT during inpatient rehabilitation for ABI, and potential mechanisms of action. Qualitative feedback from patients, families, and care providers (therapists, medical team, and dog handlers) will be collected at the completion of their engagement in the trial to determine feasibility and satisfaction with the intervention as well as potential barriers and areas for improvement. We hypothesize that the utilization of ATT in PT and OT sessions will be associated with increased patient participation, greater positive affect, and lower levels of physiological distress compared to TAU. Additionally, it is expected that the study sample will demonstrate greater improvement in functional outcomes than a historical cohort comparison group. Findings will provide evidence regarding the utility of AAT for inpatient rehabilitation of ABI and have the potential to inform and improve clinical care. If successful, this pilot will lay the foundation for transforming rehabilitation interventions for a difficult-to-engage population at risk for significant long-term functional deficits.