Rehabilitative Canine Interactions at the Walter Reed National Military Medical Center
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Rehabilitative Canine Interactions at the Walter Reed National Military Medical Center MAJ Arthur F. Yeager, SP, USA CPT Jennifer Irwin, SP, USA Due to rapid advances in the medical fi eld, effective ho- studies, guidance, and education. Participation in the listic forms of patient care are often precluded from best Service Dog Program starts with a physician, thera- practice consideration. Without evidence-based data on pist, or the Warrior Transition Brigade. Eligible service these nontraditional interventions, resources are likely members are educated on the available ADI accredited to focus more on costly equipment, complicated surger- nonprofi t organizations (NPO) that have a 501(c) tax ex- ies, and increasingly heavy use of medication. Success- emption. The WRNMMC has verbal agreements with ful programs such as animal-assisted therapy remain participating NPOs that have excellent reputations and unknown to the medical community at large and, con- strong follow-up records of their clients. Wounded War- sequently, underutilized, despite their demonstrated ef- riors cannot accept service dogs from an NPO until they fi cacy in the rehabilitative milieu. This paper highlights reach outpatient status or are living off-campus. This canine programs currently used by the US Army that requirement stems from policies aimed at protecting use trained animals and handlers to achieve specifi c patients’ health and welfare as well as their respective physical, cognitive, and psychosocial goals. service dog. Once a patient selects an organization, he or she fi lls out a referral application and submits it to the Animals are a signifi cant part of American culture and selected agency. The chosen agency makes a qualifi ca- share a symbiotic relationship throughout the history of tion determination and contacts the patient to coordinate humans worldwide. In November 2005, the American matching with a service dog that will meet their needs. Heart Association released the results of a study show- CANINES FOR COMBAT VETERANS ing that 12-minute visits with therapy dogs improved heart and lung function, reduced blood pressure, dimin- Canines for Combat Veterans (CCV) was founded to ished harmful hormones, and decreased anxiety in heart specifi cally address the unique assistance needs of com- patients.1 Despite limited therapeutic evidence in both bat Veterans and is one of several leading NPOs that the civilian and military sectors, it is reasonable to sur- provide service dogs to Wounded Warriors. Under the mise that the benefi ts of animal involvement in rehabili- auspices of the National Education for Assistance Dog tative settings can be extremely helpful for patient and Services (NEADS, also known as Dogs for Deaf and provider alike. Disabled Americans), CCV donates service dogs to Wounded Warriors from all foreign wars, past and pres- The Walter Reed National Military Medical Center ent. Additionally, they provide a 2-week training course (WRNMMC) is one such facility that is an emerging for the Veteran and a primary care assistant. This pro- leader in implementing various human-animal bond gram includes lodging, meals, and round trip transpor- programs. As the military’s fi rst combined service med- tation to their Princeton, Massachusetts training facility. ical center facility, WRNMMC currently provides sup- Customized training of the dog is completed based on port to over 500 Wounded Warriors and their Family the user’s needs prior to receipt of the dog. NEADS pro- members living in on- or off-campus facilities. Enhanc- vides ongoing monthly follow-ups with the Veteran to ing healthcare needs throughout their rehabilitation was ensure that the dog is meeting the Veteran’s needs.* the impetus for implementation of the following human- animal bond programs. Prior to its recent consolidation with the Navy National Medical Center, the Walter Reed Army Medical Center SERVICE DOG PROGRAM (hereinafter called Walter Reed) was the only medical The Service Dog Program works with civilian organi- treatment facility to use a fully trained service dog for zations accredited under Assistance Dogs International both demonstration purposes and patient interactions (ADI) (Santa Rosa, California). Currently, recipients as a therapy dog. In accordance with donation limita- of these dogs are limited to Wounded Warriors with tions and CCV guidelines, the adopted dog belonged to physical disabilities. However, research is underway a combat Veteran who was also a rehab therapist. The into extending eligibility to include Wounded Warriors *See related article on page 61. diagnosed with posttraumatic stress disorder through April – June 2012 57 REHABILITATIVE CANINE INTERACTIONS AT THE WALTER REED NATIONAL MILITARY MEDICAL CENTER handler need not possess a debilitating injury if the ser- (MATC). The MATC’s multidisciplinary team provides vice dog is used to provide patient education in a clinical Wounded Warriors with care from initial surgery to re- setting. In this case, the therapist was solely responsible integration with their units, or transition to Veterans Ad- for the health and welfare of the dog as well as gaining ministration care. supervisory guidance in the application and frequency of canine use in the clinic. The program allows certifi ed therapy dogs to work with- in an approved clinical setting while under the super- In addition to standard service dog commands, the ther- vision of a medical provider who is also the personal apist and CCV dog demonstrate the following tasks that owner of the dog. Participating dogs are certifi ed by an can be performed by most service dogs: press buttons to approved service dog or therapy dog agency, and up-to- open ADA doors,* manually open and close other doors, date medical records must be maintained within the sec- retrieve prosthetics and assistive devices, turn lights on tion where they are working. Periodic assessments and and off, open refrigerator to retrieve an object and close continuing education of the dog are documented by the refrigerator door, assist with fl oor to stand transfers, fi nd owner and or participating agency to ensure that proper up to 8 separately identifi ed objects selected by the pa- safety and training precautions are current. tient, and retrieve items like keys and even coins. As of this writing, there are 2 dogs that work regularly This program not only benefi ts many patients and their in the MATC. Their schedule and scope of practice is respective primary care assistants, it is a valuable tool for determined by the department chief, the owner/han- the multidisciplinary education of all providers. Likewise, dler, and the providers that use the dogs in their therapy. the staff member who adopts the dog gains valuable in- Wounded Warriors receiving care at the MATC may sight to the training and skill maintenance requirements participate in rehabilitation that incorporates some if not their patients will encounter. Ultimately, it assists the pa- all of the following tasks: general dog handling skills; tient and provider in making a more accurate assessment fallen/seated position to standing; retrieval of objects; of whether such a resource is appropriate and benefi cial. gait and balance training with a harness; strength and balance training with tug of war; cognitive training and PETS2VETS coordination with physical movement through sequen- The objective of Pets2Vets (Arlington, Virginia) is to al- tial movement patterns, tasks, and/or verbal commands; leviate the psychological suffering of our nation’s War- chest wall expansion through voice commands (H. riors while reducing the number of sheltered animals in Naranjo, oral communication, October 27, 2010). These the United States.2 Those benefi ciaries without physical adjunct forms of rehabilitation add graded environmen- disabilities who are not eligible for a service dog may tal complexity to purposeful activities that can improve qualify for participation in Pets2Vets. Typically, these social and therapeutic engagement via interaction with dogs do not have the training or capacity to provide the dogs. Further, these novel interventions can foster physical assistance. Instead, these “pets” are trained psychological well-being, calmness, and ultimately mo- to promote a wide range of psychosocial benefi ts well- tivate a patient to improve their quality of life by apply- known to man that are considered therapeutic, albeit ing for their own service dog. much more diffi cult to validate with tangible evidence. WARRIOR TRANSITION BRIGADE OCCUPATIONAL THERAPY To qualify for participation in Pets2Vets at WRNMMC, WORK AND EDUCATION PROGRAM active duty members or their family must participate in shelter visits, attend pet training and care classes, and There are a variety of therapeutic dog interactions of- must reside off-campus. Much like the Service Dog Pro- fered by the WRNMMC Warrior Transition Brigade’s gram discussed earlier, a provider or the Warrior tran- Occupational Therapy Work and Education Program. sition unit recommends the patient who then submits The following differ slightly by the tasks being per- an application to Pets2Vets. In turn, Pets2Vets makes formed as well as the amount of involvement by the a qualifi cation determination and follows up with the Wounded Warriors. patient for participation in their program. Warrior Transition Brigade Service Dog Training SPECIALIZED THERAPY K-9 PROGRAM Program The Specialized Therapy K-9 Program uses trained This evolving initiative was initially a collaboration of service dogs