Delavnice / Workshops Fizioterapija 2015, letnik 23, suppl 1 91 Terapija s pomočjo psov pri nevroloških pacientih pred. Maja Povše, viš. fiziot., univ. dipl. ped., Irena Dolinšek, dipl. fiziot. Univerzitetni rehabilitacijski inštitut Republike Slovenije - Soča, Ljubljana, Slovenija Korespondenca/Correspondence: Maja Povše; e-pošta: povse.maja@ir-rs.si Uvod: Živali povečujejo človekovo motivacijo, ga spodbujajo k različnim dejavnostim in tako poskrbijo tudi za gibanje (1). Najpogosteje se za terapijo z živalmi uporablja pes, saj je med vsemi živalmi človeku najzvestejši spremljevalec, je učljiv, poslušen in mobilen. Za uporabo v terapevtske namene mora izpolnjevati merila, kot so zanesljivost, predvidljivost, vodljivost, prilagodljivost in ustreznost (2). Terapija s pomočjo psov (angl. animal-assisted therapy) se uporablja pri delu v različnih javnih zavodih in ustanovah v Sloveniji in tujini. Terapija s pomočjo psov je ciljno usmerjeno posredovanje, pri katerem so psi (skupaj z vodnikom), ki ustrezajo določenim merilom, pomemben del terapevtskega procesa, opravljajo pa ga v okviru svoje stroke za to usposobljeni strokovni delavci. Program je za doseganje terapevtskega cilja skrbno načrtovan. Izvajanje programa se sproti spremlja, zapisuje in vrednoti. Prilagojen je posameznemu uporabniku (3). Namen delavnice je praktično prikazati potek terapije s pomočjo psov in njen učinek na izboljšanje gibanja pri pacientih z nevrološko okvaro. Metode: Od leta 2007 poteka program Terapija s pomočjo psov na oddelku za rehabilitacijo pacientov po nezgodni poškodbi možganov, z multiplo sklerozo in drugimi nevrološkimi obolenji. Terapijo izvajajo trije ali štirje terapevtski pari društva Tačke pomagačke in pet strokovnih delavk URI - Soča: dve fizioterapevtki, dve delovni terapevtki, logopedinja in občasno tudi psiholog. Terapije potekajo enkrat na teden in trajajo eno uro. Delo je individualno in ga ob posameznem pacientu izvajata terapevtski par (pes in njegov vodnik) ter strokovni delavec. Med terapevtskim programom potekajo dejavnosti za spodbujanje grobe in fine motorike (npr. zavezovanje rutice), naloge za izboljšanje senzibilitete (npr. božanje psa), vaje za ravnotežje in koordinacijo gibanja (npr. hoja čez psa), vadba hoje (npr. vodenje psa na povodcu), sproščanje (npr. dajanje priboljškov psu), izvajanje različnih funkcionalnih dejavnosti (npr. nega psa, oblačenje) kot tudi aktivnosti za spodbujanje govora (npr. poimenovanje delov telesa, dajanje navodil) in kognicije (npr. pogovor o psu). Cilji so izboljšanje gibanja, budnosti, pozornosti, sporazumevanja, čustvenega stanja in motivacije. Rezultati: V osmih letih se je programa udeležilo 90 pacientov po nezgodni možganski poškodbi, 91 pacientov z multiplo sklerozo, 46 pacientov s Parkinsonovo boleznijo in 78 pacientov z drugimi nevrološkimi obolenji, skupno 305 pacientov. Nekateri pacienti so se terapij udeležili večkrat. Za ocenjevanje smo uporabili enostavne lestvice, s katerimi smo na podlagi opazovanja ocenili splošno odzivnost glede na njene vidike oziroma dimenzije: gibanje, budnost in pozornost, sporazumevanje ter čustveno in motivacijsko stanje (4). Akcijska pilotna raziskava, ki je potekala od maja 2007 do junija 2008 v okviru projekta za uvajanje terapije s pomočjo psov na nevrološki oddelek, je pokazala 93-odstotni pozitivni odziv na terapijo s pomočjo psov. Zaključki: Lahko zaključimo, da se je terapija s pomočjo psov izkazala za uspešno dopolnitev fizioterapevtskih postopkov v rehabilitaciji. Učinki so pozitivni, ob psih se pacientom poveča motivacija, zato so pri izvedbi aktivnosti med terapijo s pomočjo psov pogosto zelo uspešni, kar se posledično pozna tudi v rednih terapevtskih programih. Ključne besede: pes terapevt, terapija s psi, nevrološka okvara, motorika, terapevtski cilj. Delavnice / Workshops 92 Fizioterapija 2015, letnik 23, suppl 1 Dog-assisted therapy in neurological patients Background: Animals increase person's motivation, prompting him or her to various activities, thereby also promoting movement (1). The most common animal therapists are dogs, since they are the human's most faithful companions; they are learnable, obedient and mobile. In order to become a therapist, a dog must fulfil a few requirements, such as reliability, predictability, controllability, adjustability and suitability (2). Animal-assisted therapy (AAT) is used in different public institutions in Slovenia as well as in foreign countries. Animal-assisted therapy is a targeted intervention, in which dogs (along with their handlers) that meet certain standards have an important part in the therapeutic process, which is carried out by professionally qualified therapists. The program is carefully designed for achieving therapeutic goals. The execution of the program is regularly closely observed, examined and evaluated, since the program has to be adapted for each patient individually (3). The purpose of the workshop is to practically demonstrate the course of animal-assisted therapy and its effect on the improvement of motor function on people with neurological impairment. Methods: The AAT program is used at the Department for rehabilitation of patients with traumatic brain injuries, multiple sclerosis and other neurological disorders. The therapy is performed by three to four therapeutic teams of the Tačke pomagačke association and by five professional therapists of URI-Soča: two physiotherapists, two occupational therapists, a speech therapist and sometimes also by a psychologist. Patients have therapies once a week for one hour. They are performed individually by a therapeutic team (a dog and his handler) and a professional therapist. During the therapeutic program activities for gross and fine motor functions are executed (e. g. tying up a bandana), exercises for improvement of sensibility (e. g. petting the dog), exercises for balance and movement coordination (e. g. walking over the dog), walk training (e. g. walking the dog on a leash), relaxation (e. g. giving treats to the dog), execution of different functional activities (e. g. caring for the dog, clothing it) as well as activities for improving the speech (e. g. naming the dog’s body parts, giving it instructions) and cognition (e. g. conversing about dog). The goals are an improvement of the patients’ motor functions, attentiveness, alertness, communication, and their emotional and motivational state. Results: In eight years, 90 patients after brain injury, 91 patients with multiple sclerosis, 46 patients with Mb. Parkinson’s disease, 78 patients with other neurological diseases, altogether 305 patients attended the program. Some patients attended this therapy several times. For evaluation we used simple grading scales, with which we assessed their responses based on observation according to the aspects and dimensions of the observation: movement, alertness, attentiveness, communication, emotional and motivational state of the patient (4). The pilot research took place in the context of a project aimed to introduce AAT at the neurological department (May 2007–June 2008) and it showed a 93% positive response on the therapy. Conclusions: We can conclude that during project the practising of AAT has proven to be as a successful addition to therapeutic approaches in the field of physiotherapy in rehabilitation. The effects of AAT are positive, patients’ motivation has increased in the company of dogs and these patients are therefore often very successful in executing activities and consequently also in usual therapeutic programs. Key words: therapy dog, animal-assisted therapy, neurological impairments, motorics, therapeutic goals. Literatura/References: 1. Bergler R, Hoff T (2010). Fascinantni izsledki raziskav: Živali zdravilno vplivajo na človeka. Dostopno na spletnem naslovu: http://www.ekomagazin.si/Zdravje/Zdravje/Fascinantni-izsledki-raziskav-Zivali-zdravilno- vplivajo-na-cloveka.html (citirano 15. 3. 2015). 2. Fine HA (2006). Animal-assisted therapy: theoretical foundations and guidelines for practice. San Diego, London: Academic Press, 123–6. 3. Društvo Tačke pomagačke. Dostopno na spletnem naslovu: http://tackepomagacke.si/programi/terapija-s- pomocjo-psov (citirano 18. 3. 2015). 4. Kovačič D (2008). Poskusni program rehabilitacije s pomočjo psov. Rehabilitacija, let. 7, št. 2: 23–9.