Conceived and designed the experiments: 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.
Forty children 3—17 years were enrolled in the randomised open-label, animal assisted activities allergies, pilot study. 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, animal assisted activities allergies, heart rate, blood pressure, oxygen saturation, animal assisted activities allergies, cerebral prefrontal oxygenation, salivary cortisol levels and the faces pain scale were considered as outcome measures.
Systolic and diastolic blood pressure were influenced by animal-assisted therapy, though a higher variability in diastolic pressure was observed. 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. The relationship between human beings and animals, especially dogs, has existed for thousands of years.
Historically, animals have held an important role in this relationship as they provide company, stimulus and motivation. Animals are excellent company, since they do not discriminate or segregate anyone, animal assisted activities allergies, that is, they are free of prejudice animal assisted activities allergies 1 ]. In spite of the long-lasting presence of companion animals in human life, the idea that interaction with animals may exert a positive effect on human health is rather recent [ 2 ].
AAT in particular, is a goal-directed intervention in which an animal that meets specific criteria is an integral part of the treatment process. AAT is technically defined as the use of trained animals by trained health professionals to facilitate specific, measurable goals for individual patients for whom there is documented progress [ 3 ]. Interest in AAT has been fueled by studies supporting the many health benefits.
AAT has proven a useful adjunct in a variety of settings including mental health facilitaties [ 4 — 10 ], nursing homes [ 1112 ] and hospitals animal assisted activities allergies 1314 ] where most studies have been performed with adult patients with variable interventions, goals, patient characteristics and patient needs.
In these studies, animal assisted activities allergies, AAT resulted in significant reductions in anxiety, agitation and fear. In children, AAT dogs decreased distress during painful medical procedures, promoted calmness in children with post-traumatic stress disorders and increased attention and positive behaviors in children with pervasive developmental disorders [ 1015 — 19 ].
Surgical procedures and hospitalization can be stressful for both children and their parents and they are associated with pain, helplessness, fear and boredom [ 19 ]. Emotion regulation is the adaptive behavioural response to stress. Emotions promote biochemically-mediated neurologic responses to emotionally-based stimuli [ 20 ].
Neurophysiologic measurement based on electrophysiological techniques can detect a wide range of dynamics of the emotional state by directly accessing the fundamental structure in the brain from which an emotional state emerges [ 2122 ]. Hormonal indicators, such as cortisol level, and autonomic measurements, for example heart rate, blood pressure, animal assisted activities allergies, can objectively detect the physiological responses of the endocrinological and autonomic nervous systems related to stress [ 2223 ].
The purpose of this study was to better understand the effects of an AAT program on neurological, cardiovascular and endocrinological responses to stress and pain in the immediate post-operative period in children undergoing surgical procedures. The study was performed according to the Declaration of Helsinki.
No invasive intervention or drug sperimentation on the dog was performed; therefore the application of D. The dog owner provided consent for its use in the study. The study was registered at ClinicalTrials. This was a randomised open-label, controlled, pilot study. The different arms consisted of an experimental group with a AAT session after a surgical procedure and a control group with standard care after surgery.
The flow diagram of the progress through the phases of randomization is reported in Fig 1. The outcomes of the study were to define the impact of AAT on neurological primary endpointcardiovascular secondary endpoint 2 and endocrinological signs secondary endpoint 3in response to stress and pain in children undergoing surgical procedures. After trial commencement, no changes to the methods or trial outcomes were made. Forty immunocompetent children both gendersaged 3 to 17 years, undergoing surgical procedures including orchidopexy, inguinal or umbelical hernia repair, circumcision, varicocele treatment were sequentially enrolled in this study.
A sample size of 20 patients per group for a total of 40 subjects was determined based dog availability. No data in the literature were available. In all subjects, surgery was performed between 8. Parental permission was obtained through a written and oral informed consent. Written assent by the patient was also obtained in children eight years of age and older before enrolment.
Prior to the study, the animal assisted activities allergies underwent rigorous screening although she had previous experience in Animal Assisted Interventions and was already trained and prepared for this type of work. The animal assisted activities allergies was fully vaccinated, bathed regularly, screened for enteric pathogens, and treated for internal and external parasites on a monthly basis.
The participants were followed for the duration of the immediate postoperative period, an expected average of four hours. At admission, auxological examination of the children included measurement of height, weight and body mass index. Height measurement was performed using a Harpenden stadiometer, performed with patients in an upright position, without shoes, with their heels together, arms extended down the sides of the body and head positioned parallel to the floor.
Weight was measured with the children barefooted and wearing light clothes, animal assisted activities allergies, standing upright in the centre of the scale platform with their arms extended down the sides of the body.
BMI was calculated as body weight in kilograms divided by body height squared in meters. Pre-surgery, the children were randomly assigned to the experimental AAT-group where the dog was present during post-operative awakening 2 hours after surgery or the standard-group STAND-group where children had standard post-operative medical care. The therapy dog was specially prepared and chosen for the interactions, animal assisted activities allergies, which were evaluated as suitable and registered together with the handler.
The STAND-group underwent the same measurements over the same time frame, but without the dog being present. EEG activity, cerebral prefrontal oxygenation, animal assisted activities allergies, heart rate, blood pressure, oxygen saturation, salivary cortisol levels, faces pain scale were considered as indicators of neurological, cardiovascular and endocrinological response to stress and pain.
Any change in the normal physiological structure of the EEG, correlating the effect of the anaesthesia, post-operative stress of AAT intervention was recorded and monitored. In both cases, the protocol included an EEG recording tasting about 20 minutes, while awake, with open and closed eyes.
Salivary cortisol levels were measured at T1, animal assisted activities allergies, after Animal assisted activities allergies and T3. After thawing, animal assisted activities allergies, salivary fluids were centrifugated to precipitate mucins and cortisol was assayed in the supernatant with a solid-phase radioimmunoassay, wherein I labeled cortisol competes for a fixed time with cortisol in the biological sample The Coat-A-Count Cortisol, Siemens, Los Angeles, CA.
This scale consisted of 6 cartoon faces with varying expressions ranging from very happy to very sad. The child rated animal assisted activities allergies pain intensity on a scale, with point 0 being no pain and point 10 being the worst pain. Analgesic treatment in the first 12 hours post-intervention was recorded.
Written consent was obtained from the parents of the children scheduled for surgical procedures. All subjects were in good physical condition. Anesthesia included propofol animal assisted activities allergies. After laryngeal mask or tracheal tube positioning, animal assisted activities allergies, patients underwent volume controlled mechanical ventilation with an inspired mixture of air and oxygen using a closed breathing system fresh gas flow of 0.
Anesthesia was maintained via administration of Sevoflurane gas. Sevoflurane was administered in a 0. At the end of the operation, the patient animal assisted activities allergies transferred from the operating theater to the recovery room and subsequently was re-admitted to the Unit. Continuous variables were described as the mean and standard deviation SD or median and quartiles and categorical variables as counts and percentages.
The prevalence of EEG beta activity was compared with the Fisher exact test. To test the effects of AAT on vital signs and on endocrinological parameters over time in the two groups, regression models for repeated measures were used, including a main effect for group and time, as well as their interaction; the latter was used to assess treatment effect comparison of profiles over time.
We also included a term for the duration of anesthesia, which was unbalanced between groups. Model assumptions were checked by visual inspection of the residual vs. Distribution of pain scores at the end of the session in the two groups was compared with the Fisher exact test. No multiple test correction was applied given the exploratory nature of the pilot study.
All statistical analyses were performed using Stata The 40 animal assisted activities allergies 32 M and 8 F; mean age 7. Demographic, auxological features at admission and vital signs pre experimental intervention are reported in Table 1. Differences in treatment effect at every step during the intervention are detailed in Table 2.
Given a marked inbalance in anesthesia time between animal assisted activities allergies, all models were adjusted for this difference. Some differences in the time profile between groups were observed for heart rate, oxygen saturation and cerebral oxygenation, animal assisted activities allergies. Four cases in the AAT group had a reduction in pain from a level of six to zero. No differences in analgesic treatment in the first 12 hours post-intervention were recorded in the groups.
Surgery is one of the most stressful events a child may experience. The effects of AAT in pediatric surgery have not been described yet. We showed that AAT intervention during post-surgical procedures induces neurological and cardiovascular responses in the immediate post-operative period in children undergoing surgical procedures.
Early vigilance recovery and activity after anaesthesia and activation of the emotional prefrontal area were noted in the AAT-group. AAT has been utilized world-wide, as ofand consists of animals animal assisted activities allergies therapeutic training for patients with emotional, physical and mental diseases.
In the presence of these animals, animal assisted activities allergies, patient levels of anxiety and stress are reduced following painful procedures, physical activity is stimulated and interpersonal relationships, self-care and cardiovascular parameters are improved [ 1928 — 33 ]. The presence of atypical alpha-like 10—14 Hz activity in anterior derivations frontal and temporal was observed during post-operative wakening in almost all of the STAND patients; this finding may be related to propofol treatment [ 3435 ].
This activity, as reported in the literature, was constant throughout the duration of the postoperative recording, tending to fragment and disappear in the hours and days following anaesthesia.
The 20 patients in the AAT-group, 2 hours after post-operative awakening, animal assisted activities allergies, also showed the presence of atypical anterior alpha-like EEG activity.
However, after the AAT intervention their Hydrocodone acetaminophen showed a quick and clear tendency to fragment the alpha-like activity up to its disappearance and replacement by quicker beta activity usually observed in awakening or during activities that require attention. The more rapid disappearance of the propofol-induced atypical alpha-like anterior activity in patients in the AAT-group compared to the STAND-group is clear in our protocol; therefore, even though AAT stimulation is new and innovative with few mentions in the literaturewe can affirm that an early post-operative intervention with AAT stimulation could facilitate a rapid recovery of vigilance and activity after anaesthesia with propofol, animal assisted activities allergies.
Hemodynamic changes during assessment of brain activity have been described [ 36 ]. The autonomic nervous system regulates involuntary body functions and is commonly evaluated by measuring systolic and diastolic blood pressure and heart rate reflex responses to physiological and pharmacological stimuli. In this study, the autonomic cardiovascular changes in HR and blood pressure could be considered as adaptative responses correlated to an early neurological response.
Autonomic nervous system activity is an important component of human emotion. Mental processes influence bodily physiology, which in turn feeds back to influence thoughts and feelings. Afferent cardiovascular signals from arterial baroreceptors in the carotid sinuses are processed within the brain and contribute to this two-way communication with the body [ 22 ]. Several studies compliances about medical weight loss clinics investigated the pain-relieving effects of dog therapy in pediatric and adult patients and significant pain reduction has been reported reported [ 1937 ].
EEG, although limited by its poor spatial age appropriate acetaminophen and high susceptibility to animal assisted activities allergies, has been widely used to investigate the brain dynamics relative to emotion as it enables the detection of immediate responses to emotional stimuli with excellent temporal resolution [ 21 ].