PhysioUpdate 12th October 2021


Dog's visits to an intensive care unit motivated patients and staff, claims physiotherapist

Allowing a trained dog with a volunteer handler to visit an NHS intensive care unit (ICU) in Leicester proved to be a big hit among patents, staff and visitors alike, according to an article published in a specialist physiotherapy journal.

The article, which appears in the current issue of the Journal of the Association of Chartered Physiotherapists in Respiratory Care, was written by Ruth Johnson, an ICU physiotherapist at Leicester Royal Infirmary.

 

The visiting dog and handler had links with Pets as Therapy, which supplied this image

Ms Johnson’s article helps to plug something of a gap in the field, because the benefits of animal assisted interventions (AAIs) – defined as interventions between an animal and a patient during a medical, nursing or therapeutic procedure – have rarely been researched in critical care settings.

The dog, which a recent Twitter post from Ms Johnson suggests is called Cilla, was accompanied by a handler from a charity called Pets as Therapy.

No hygiene concerns

After the visits, most of which lasted fewer than 20 minutes with individual patients and were conducted on a weekly or fortnightly basis, questionnaires (which included a 10-point rating scale and invited written comments) were circulated to two groups: patients and visitors, and members of staff.

Summarising the responses received from 47 individuals, Ms Johnson writes: ‘There were no concerns in relation to the dog’s presentation, welfare, cleanliness or handling highlighted by responders.’

An overwhelming majority of patients and visitors said they had enjoyed the experience, with 83 per cent of them giving it the highest possible rating. A slightly lower percentage of staff (70 per cent) gave the same maximum score when asked to rate patients’ enjoyment levels, but three quarters of respondents (75 per cent) from both groups said they had found the experience to be ‘highly beneficial’.

Almost all (95 per cent) of respondents said they recommended that the AAI service should be introduced in other wards and hospitals.

The paper continues: 'The volunteer determined the length of the interaction dependent on the behaviour of the dog, person(s) involved and perceived benefit for all.

'Most interactions were less than 20 minutes long. The interaction involved verbal communication and touching the dog during periods of rest, delivery of care or treatment. The maximum total length of time the dog visited was 120 minutes on any one day, with regular welfare breaks for the dog.'

 

'Amazing interaction' noted by physio

EVERYWHERE should have this input. Nothing but positive experience and outcomes for all involved – patients, visitors and staff [nurse respondent]

One man said the dog’s presence had led to his partner walking ‘for the first time in days’. And a physiotherapist reported: ‘The therapy dog visited ITU today, the patient walked to (the dog) as her goal and this was amazing. The interaction between the patient and (the dog) was very emotional. This was an amazing way of encouraging mobility,’ the physiotherapist added.

A staff nurse’s comments showed that it was not just the patients who received some welcome stimulation from the dog’s visits. ‘EVERYWHERE should have this input. Nothing but positive experience and outcomes for all involved – patients, visitors and staff.'

The nurse added: ‘Staff actively look forward to the visit. And is often used as motivation and something to look forward to for patients.’

A doctor felt more compassionate

This perceived boost to the staff’s feelings of wellbeing was reinforced by the enthusiastic comments from a doctor on the unit, who said: ‘I really hope (the dog) will visit regularly during the winter pressures as I think staff will benefit so much, helping us all stay well for our patients.’

On a personal level, the doctor added that ‘the dog helped me to de-stress and helped me to deliver better, more compassionate care for our patient’.

Overcoming 'dehumanisation' effects

Ms Johnson’s article points out that significant numbers of patients who survive a critical illness go on to develop a condition known as post-intensive care syndrome.

Citing previous findings and National Institute for Health and Care Excellence guideline recommendations on critical care practice, she notes: ‘In modern critical care medicine, the promotion of recovery, over mere survival, for both physical and non-physical domains, is the main rehabilitation objective.’

Researchers have suggested that critical care patients require personalised rehabilitation prescriptions to meet their individual physical and non-physical needs, the article stresses.

Patients are at risk of ‘dehumanisation’, which can ‘negatively impact on patient engagement and interest in their own well-being during the rehabilitative phase’, Ms Johnson adds.

This evaluation identifies that a service providing AAIs to adult patients in ICU is safe and feasible ... it highlights additional perceived benefits for visitors, staff and patients [Ruth Johnson]

Ms Johnson suggests that the study could provide a basis for further research on AAI initiatives. She admits that a study of this nature cannot rule out bias, particularly as, in this case, the dog handler was also the researcher.

Allergy taken into account

Apparently, no one raised objections in advance regarding the dog’s visits – most of which took place during afternoon visiting hours. ‘Potential risks were identified during a pre-visit telephone call on the day of the visit. One staff member highlighted a mild dog allergy and the handler ensured that there was no contact between the dog and this staff member.’

In her conclusion, Ms Johnson writes: 'This evaluation identifies that a service providing AAIs to adult patients in ICU is safe and feasible. It highlights additional perceived benefits for visitors, staff and patients. In addition, a number of recommendations for service development and future research have been highlighted.’

To read the full version of Ms Johnson’s article, visit: https://www.acprc.org.uk/data/Journal_Downloads/JournalVol53Issue22021.pdf

To find out more about the Association of Chartered Physiotherapists in Respiratory Care, visit: https://www.acprc.org.uk

For more information about Pets as Therapy, visit: https://petsastherapy.org

 



Academics and engineers exploit new technologies to make shorter rehabilitation times a reality
Kareema Hilton holds elements of the flexible design created through additive manufacturing

Ambitious plans to use virtual reality technology to help patients with dystonia, strokes and sports injuries have been unveiled by the National Manufacturing Institute Scotland (NMIS).

Academic and engineering experts from the University of Strathclyde and NMIS are linking up with a range of international agencies to reduce rehabilitation times by up to 30 per cent, it was announced today (24 September).  

With research studies showing that patients’ rehabilitation goals can be hampered because traditional programmes are insufficiently stimulating or speedy, the initiative has huge potential, NMIS claims. See: https://pubmed.ncbi.nlm.nih.gov/19514635

The project leaders also hope that the physical demands currently being placed on physiotherapists and occupational therapists could be reduced by harnessing the latest technological advances.

Virtual support

Using a ‘level-based system’, patients make progress through completing online games, with staff tracking their progress using gaming data and offering support virtually.

Patients follow personalised activities that are created according to their unique set of cognitive and physical impairments, and develop upper body motor skills using their arms, wrists, hands and fingers.

For example, those with dystonia can practise pouring water into a glass in the virtual world so that they won’t spill a drop in reality.

3D printing

A company called Loud1Design is helping to develop the virtual programme and a create prototype bespoke video game controller. This will be custom-made for each patient, according to his or her condition and personal needs. A manufacturing process, which uses a form of 3D printing in which an object is built one thin layer at a time, will allow for customisation.

Coordinated by the University of Pisa, the project's partners include the universities of Malta and Oulu (in Finland), University College London, and others in the industry. Saint James Hospital in Malta, Kinisiforo and NicoMed rehabilitation centre in Cyprus (https://nicomedrehab.com/kinisiforo), and the Global Disability Innovation Hub (https://www.disabilityinnovation.com) are providing patient requirements and will monitor progress when the prototypes are complete. 

The use of additive manufacturing demonstrates the benefits of a flexible design that can be made bespoke to an individual user – in this case to support an individual’s physical needs to assist rehabilitation [Kareema Hilton, NMIS]

Kareema Hilton, manufacturing engineer at the NMIS said: ‘This is a fantastic project that is allowing us to use developments within digital technology to potentially improve healthcare. The use of additive manufacturing demonstrates the benefits of a flexible design that can be made bespoke to an individual user – in this case to support an individual’s physical needs to assist rehabilitation.’

Andrew Wodehouse, senior lecturer at the department of design, manufacturing and engineering management at the University of Strathclyde, said: ‘The outcome of this project will make the long recovery process more engaging while permitting the patient’s performance to be recorded accurately, allowing specific and measurable goals to accelerate rehabilitation time.

‘We are all looking forward to the completion of the project, as it will provide a significant milestone for interactive technology in improving physical health and performance.'

The initiative is funded by the European Commission as part of Horizon 2020, which aims to encourage economic growth through research. The two-year PRIME-VR2 project will create a digital environment using virtual reality in rehabilitation programmes.

At least three physiotherapists are members of the PRIME-VR2 team: Chara Vasiliou, who works at the Nicomed Rehabilitation Centre in Limassol with patients with stroke and other neurological conditions; Milos Stanisavljevic, who is responsible for the day-to-day management and administration of Planet Health International at Saint James Hospital in Malta; and Andreas Ioannou, who works at the Nicomed Rehabilitation Centre with patients who have had a stroke and with children with cerebral palsy. 

For more information about NMIS, visit: www.nmis.scot

Project website: http://prime-vr2.eu

Project video: https://youtu.be/BAXio2igIBM

 



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