Using Dogs to Promote Therapeutic Engagement During Inpatient Rehabilitation Following Pediatric Acquired Brain Injury: Understanding Mechanisms and Moderators of Treatment Response

在儿科获得性脑损伤后住院康复期间使用狗促进治疗参与：了解治疗反应的机制和调节因素

• 批准号: 10308160
• 负责人: Megan Narad
• 金额: $ 37.39万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-09 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10308160
• 关键词: Address; Admission activity; Adolescent; Affect; Age; Aggressive behavior; Animals; Auditory; Behavior; Behavioral; Brain Injuries; Canis familiaris; Characteristics; Child; Child Care; Childhood; Clinical; Clinical Trials; Code; Cognitive; Cross-Over Trials; Crossover Design; Data; Data Collection; Distress; Effectiveness; Emotional; Ensure; Family; Fatigue; Feedback; Fright; Goals; Health; Human; Impaired cognition; Infection; Injury; Inpatients; Intervention; Lead; Length of Stay; Life; Link; Literature; Measures; Mediating; Mediator of activation protein; Medical; Methodology; Methods; Moods; Motivation; Occupational Therapist; Occupational Therapy; Outcome; Oxytocin; Pain; Parents; Participant; Patient Admission; Patient Self-Report; Patients; Pediatric Brain Injury; Pediatric Hospitals; Personal Satisfaction; Physical Medicine; Physical therapy; Physicians; Physiological; Population; Positioning Attribute; Psychologist; Randomized; Rehabilitation therapy; Reporting; Research; Risk; Salivary; Sampling; Severities; Social Interaction; Specialist; Technology; Testing; Therapeutic; Time; Translating; Trauma; Videotape; Visual impairment; Work; animal-assisted therapy; clinical care; design; disability; efficacy evaluation; emotional adjustment; evidence base; facial recognition software; functional disability; functional improvement; functional outcomes; functional status; improved; improved outcome; innovation; innovative technologies; insight; multidisciplinary; novel; patient engagement; physical therapist; pilot trial; positive mood; psychosocial; recruit; safety and feasibility; social; success; treatment as usual; treatment response; tumor; volunteer

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 crossover trial seeks to determine the effect 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. Data will be collected during four therapy sessions across two weeks (2 in week 1 of admission and 2 in week 2 of admission). AAT, via integration of dogs into patient's physical therapy (PT) and occupational therapy (OT) session, will occur during one of the two sessions in the first week and one of the two sessions the second week. The non-AAT condition will be treatment as usual (TAU) as defined by the patient's treatment team, resulting in 2 AAT sessions and 2 TAU sessions total. The order of condition will be randomized separately for each week. We will recruit 90 patients ages 4-21 being treated for ABI on the inpatient rehabilitation unit at CCHMC. 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) determine the effect of AAT on patient engagement in inpatient rehabilitation therapies, 2) examine potential mechanisms of action for AAT-associated improvement in patient engagement (mood and physiological distress), and 3) determine factors that moderate the effect of AAT on patient engagement (patient anthropomorphism, patient-animal closeness, time course in admission, and demographic and injury characteristics). We hypothesize that a greater level of patient engagement will be observed during AAT sessions compared to treatment as usual (TAU) sessions. Additionally, AAT will be associated with more positive mood and lower levels of distress, which in turn will be related to greater patient engagement. Finally, a greater effect of AAT will be noted earlier during patient admissions, and greater levels of anthropomorphism and patient-animal closeness will be associated with greater levels of patient engagement during AAT sessions. We propose the use of novel methodology and innovative technology in data collection designed to address concerns related to bias and reliance of subjective outcomes in the AAT evidence base. This innovation positions the project to fill an important gap in the existing AAT literature. Findings will provide critical new insights into why pediatric inpatients benefit from AAT and who is most likely to benefit. We will translate our findings to ultimately improve functional outcomes following pediatric brain injury, a leading cause of disability.

抽象的 在住院康复病房接受治疗的获得性脑损伤 (ABI) 儿童面临着巨大的风险 长期功能障碍，强调最大化有效性和利用的重要性 住院康复治疗。拟议的交叉试验旨在确定动物辅助的效果 儿科获得性脑损伤后住院康复期间的治疗（AAT）。为了实现这一点 客观上，我们将采用受试者内交叉试验。将在四次治疗期间收集数据 跨越两周（入院第一周 2 周，入院第 2 周 2 周）。 AAT，通过将狗融入 患者的物理治疗 (PT) 和职业治疗 (OT) 疗程将在两者之一期间进行 第一周举行两次会议，第二周举行两次会议之一。非 AAT 条件将是 患者治疗团队定义的照常治疗 (TAU)，导致 2 次 AAT 疗程和 2 次 TAU 会话总数。每周的条件顺序将分别随机排列。我们将招募90名患者 4 至 21 岁的患者在 CCHMC 住院康复科接受 ABI 治疗。我们聘请了高度 合格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) 确定 AAT 对患者参与住院康复的影响 疗法，2) 检查 AAT 相关改善患者参与度的潜在作用机制 （情绪和生理困扰），3) 确定调节 AAT 对患者影响的因素 参与度（患者拟人化、患者与动物的亲密程度、入院时间以及 人口统计和伤害特征）。我们假设患者的参与度会更高 与常规治疗 (TAU) 疗程相比，在 AAT 疗程中观察到的情况。此外，AAT 将 与更积极的情绪和更低的痛苦水平相关，这反过来又与更多的患者相关 订婚。最后，AAT 的更大作用将在患者入院期间更早地注意到，并且水平更高 拟人化和病人与动物的亲密关系将与更高水平的病人相关 AAT 会议期间的参与度。我们建议在以下方面使用新颖的方法和创新技术 数据收集旨在解决 AAT 中与主观结果的偏见和依赖相关的问题 证据基础。这一创新使该项目填补了现有 AAT 文献中的一个重要空白。 研究结果将为了解为什么儿科住院患者从 AAT 中受益以及谁最有可能受益提供重要的新见解 受益。我们将转化我们的研究结果，最终改善儿科大脑的功能结果 伤害，是导致残疾的主要原因。