Splošne teme 2 / General themes 2 Fizioterapija 2013, letnik 21, suppl 1 Aktivnosti in terapija s pomočjo psov: uporaba v fizioterapiji Tjaša Knific, dipl. fiziot.1, pred. Mojca Divjak, viš. fiziot., univ. dipl. org.2 1Inštitut za varovanje zdravja Republike Slovenije, Center za krepitev zdravja in obvladovanje kroničnih bolezni, Ljubljana, Slovenija; 2 Zdravstvena fakulteta, Univerza v Ljubljani, Slovenija Korespondenca/Correspondence: Tjaša Knific; e-pošta: tjasa.knific@ivz-rs.si Uvod: Aktivnosti in terapijo s pomočjo psov (ATP) vključujemo v obravnavo bolnikov z motoričnimi, senzoričnimi ali senzomotoričnimi motnjami. Prizadeti osebi tako omogočamo fizično, socialno, kognitivno in tudi emocionalno sprostitev oziroma napredovanje (2). Ločimo aktivnost in terapijo s pomočjo psov, ki se razlikujeta v načrtnosti, zahtevnosti in globini vplivanja (2). Aktivnosti s pomočjo psov (AP) dajejo možnost za motivacijske, izobraževalne, sprostitvene in terapevtske koristi, ki izboljšujejo kakovost življenja. Enake aktivnosti lahko ponavljamo z različnimi uporabniki oziroma skupinami. V tem programu ni točno določenega cilja. Gre za obliko druženja s psom (2). Terapija s pomočjo psov (TP) pa je ciljno usmerjeno posredovanje, pri katerem so psi, ki ustrezajo določenim kriterijem, pomemben del terapevtskega procesa. Program je skrbno načrtovan in zastavljen po korakih za dosego terapevtskega cilja. Terapevtski proces mora biti v celoti ovrednoten in dokumentiran, imeti mora merljive cilje (3). Namen prispevka je predstaviti primer ATP v fizioterapiji, prikazati način uporabe ter vrste in učinke terapije s psi. Metode: V okviru prispevka o izvajanju ATP so predstavljeni pogoji, ki jih je treba zadovoljevati, če želimo uspešno izvajati program. Pred izvedbo programa ATP so potrebne priprave, ki vključujejo pripravo terapevtskega psa, vodnika, interdisciplinarnih članov tima in ciljne skupine. Če želimo sestaviti dober program TP, je treba dobro oceniti pacientove težave, ovrednotiti njegovo stanje in upoštevati dogovorjene cilje fizioterapije. Fizioterapevt, ki se je odločil za uporabo TP, naj bi imel poglobljeno znanje o tem, kako, zakaj in kdaj uporabiti terapevtski par pri obravnavi posameznika. Pri izvajanju TP je zato potreben začetni pogovor z vodnikom psa in bolnikom, pri čemer se določijo cilji terapije. Pri tem se upoštevajo bolnikove želje, njegove trenutne sposobnosti, kontrolne točke in načini evalvacije terapije, ki pa morajo biti kompatibilni z dogovorjenimi cilji fizioterapije. Ko so zbrane vse potrebne informacije, se pripravi načrt o poteku srečanj, načrt obravnave, izberejo se namenske aktivnosti, opredelijo se kratkoročni in dolgoročni cilji. Terapija s pomočjo psa naj bi potekala v času fizioterapevtske obravnave posameznega pacienta. Najpogosteje se pes pri terapiji uporablja kot spremljevalec pri hoji prizadete osebe ali za trening ravnotežja in vertikalizacije najzahtevnejših bolnikov. Zaključki: Zaradi pomanjkanja randomiziranih kontrolnih študij o učinkovitosti ATP pri večji populaciji različnih pacientov o učinkovitosti ATP še ne moremo govoriti. Dejstvo je, da se svetovni trendi uporabe ATP uveljavljajo tudi v Sloveniji. ATP je dobrodošla dopolnitev kompetentne fizioterapevtske obravnave in rehabilitacije pacienta, saj povečuje bolnikovo motivacijo za delo. Pes je medij med bolnikom in terapevtom ter tako olajša delo rehabilitacijskemu timu, saj bolniki tako hitreje pridobijo zaupanje v terapevta. Prihodnji interes terapevtskih timov bi moral biti usmerjen v izvedbo več kontrolnih kliničnih študij o vplivu in učinkih TP. Ključne besede: aktivnosti in terapija z živalmi, terapija s psi, pasji terapevti, integralna fizioterapija, rehabilitacija s pomočjo psov. Splošne teme 2 / General themes 2 Fizioterapija 2013, letnik 21, suppl 1 Dog assisted activity and treatment: use in physiotherapy Background: Dog-assisted activities and therapy are included in the treatment of patients with motoric, sensoric or intellectual sensomotoric disorders and enable physical, social, cognitive and emotional release and progress to disabled persons (2). We distinguish between activity and therapy with dogs, which vary in planning, complexity and extent of influence (2). Dog assisted activity give us an opportunity for motivational, educational, relaxing and therapeutic benefits that improve quality of life. The same activity can be repeated with different users or groups. It is a form of socializing with dogs. This program is not objectively well-defined (2). Therapy in which we use dogs is a targeted intervention in which we use dogs who meet specific criteria. They are an important part of the therapeutic process. The program is carefully designed and set-by-step to achieve a therapeutic goal. Therapeutic process must be fully evaluated and documented with measurable objectives. The purpose of the contribution was to present dog-assisted activities and therapy in physiotherapy, to show how to use this type of therapy in practice and to show the types and effects of dog therapy. Methods: In the framework of the presentation of dog-assisted activities and therapy in physiotherapy, the required conditions, which are necessary for successful program implementation, are presented. Certain preparations, such as the preparation of the therapeutic dog, guider, interdisciplinary team members and patients, are necessary prior to the implementation of dog-assisted activity and therapy program. In order to create a successful dog-assisted therapy program, it is crucial to assess patients problems, evaluate his condition and compliance with agreed physiotheraphy program. The physiotherapist, who has decided to use the TP should have in-depth knowledge of how, why and when to use a therapeutic pair in the treatment of a patient. In the implementation of TP that requires an initial conversation with a dog guider and patients, where pledge goals of therapy, the patient's wishes, his current ability, control points and methods of evaluation are pointed. All this must be compatible with the agreed goals of physiotherapy program. When all the necessary information have been collected, we have to prepare a plan of progress meetings, treatment plan, choose the dedicated activities and identify short-term and long-term goals. Dog-assisted theraphy should take place during physiotherapy, which is assigned to each patient. The most commonly used therapy with a dog is a walking therapy or balance training and verticalisation of complex patients. Conclusions: The lack of randomized controlled studies on the effectiveness of ATP to a larger population of different patients can not speak truly about effectiveness of ATP. The fact is that the global trends in ATP have also been introduced in Slovenia. ATP is a great addition to a competent physiotherapy treatment and rehabilitation of the patient, as it increases the patient's motivation. A dog is a medium between a patient and a therapist in order to facilitate the work of the health team, because patients in this way quickly gain confidence in the therapist. Future interest in the therapeutic team should be focused on the performance of several controlled clinical studies on the effectiveness of TP. Keywords: animal-assisted activities and therapy, dog therapy, integral physiotherapy, rehabilitation with dogs. Literatura/References 1. Helton WS (2009). Canine ergonomics, the science of working dogs. Florida: Taylor & Francis group; 281–99. 2. Delta society- AVMA policy (2007). Wellness guidelines for animals in animal-assisted activity, animal assisted theraphy and residental animal programs. www.deltasociety.org . <27. 5. 2010> 3. Becker M (2002). The healing power of pets. First edition. New York: Hyperion.