Running head: LITERATURE REVIEW 1

Literature Review

Selina Dykes

Grand Canyon University: NSG 324

March 28, 2020

LITERATURE REVIEW 2

Literature Review

Adolescents’ brains are continuing to develop during this age and are vulnerable to

various stimuli that can alter this development. At this point in their life, adolescents are

experiencing not only physical changes but mental and hormonal changes as well. Children with

Autism Spectrum Disorders (ASD) have many difficulties with speech and social cues. A

common issue that comes with having a diagnosis like this is it can be hard for these patients to

have a social life and cultivate social skills which is crucial to develop. In this age group, being

social is a large part of growing and can be difficult for someone with a disability like autism.

“The theory behind human animal interaction (HAI) therapy is that animals are a source of non-

judgmental support and can facilitate social interaction” (Yap, Scheinberg & Williams, 2017).

This is important to utilize because the goal of animal assisted therapy is to help build new skills

for these patients during a tough judgmental time in their lives. By incorporating animals, it

allows for patients to express and practice social skills without the disturbance of being made fun

of or judged by peers. The topic of discussion in this review is whether animal assisted therapy

creates a safe environment for physical and psychosocial wellbeing and growth. “It is believed

that exercises performed on unstable surfaces (e.g., when riding a horse) stimulate the

neuromuscular control, stabilize the joints, and increase proprioception, as well as muscle control

and its coactivation” (Zaliene, Mockeviciene, Kreiviniene, Razbadauskas, Kleiva & Kirkutis,

2018). Various animals especially horses allow patients to use animal assisted therapy in order to

gain motor function as well as social aspects of skills back which can be beneficial in autistic

patients. This analysis will review three different articles in order to provide support for the

PICOT question of: In adolescent patients ages 10-19 and patients diagnosed with cerebral palsy,
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does the use of animal-assisted therapy compared to no animal-assisted therapy increases the

patient’s motor function within 6 months of utilizing an animal therapy program?

Methods

When determining which articles would offer the best information regarding the

implementation of animal assisted therapy (AAT) there was certain criteria used. The first

principle used was that the article had to come from a credible source. To achieve this, a

database was used that incorporated peer-reviewed articles and journals. By applying these, the

articles chosen were valid and relevant to the specific PICOT. Other criteria applied was the

article had to be recently published meaning within the past five years. Because the healthcare

field is constantly evolving, it is imperative that only articles published within this time frame

because they can quickly become outdated. An additional standard used was the article had to

present itself as either quantitative or qualitative. This is because these types of articles provide

the necessary information with crucial evidence to support the PICOT question. Other types of

articles such as meta-analysis would not provide concrete evidence with statistics or behaviors

but rather with varying opinions of each side of the question being asked. Furthermore, the last

criteria used was the author had to be credible. This means that the authors had to have their

articles peer-reviewed and contributed to medical research.

Synthesize of Literature

Each article chosen for the study of the AAT PICOT question had similarities when it

came to the material being displayed. The first article was titled, Therapeutic Horseback Riding

and Children with Autism Spectrum Disorders. This was a quantitative article included 45

children diagnosed with an autistic disorder and a control group. Methods involved sessions with

the patients were set up to 40 hours a week and the students were provided specialized training
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with the horses. They included interventions that targeted balance and coordination, stimulated

gross, sensory and fine motor domains as well as verbal communication. The authors concluded

that when analyzing problematic behaviors, they were greatly reduced that could be due to the

distraction of the horses occupying the student (Al-Hmouz & Arabiat, 2015). This article

supports the PICOT question because it demonstrates a different breed of animal besides a

canine. It allows for diversity and variety in the theme of “animal” assisted therapy.

Additionally, this article supports the use of animal assisted therapy and that it positively effects

patients who have specific disorders.

The second article is titled, Effects of Animal-Assisted Therapy on Concentration and

Attention Span in Patients with An Acquired Brain Injury: A Randomized Controlled Trial. This

quantitative article included 22 patients that had been diagnosed with traumatic brain injuries.

They were given two therapy sessions over the period of six weeks that involved the use of

animals and how they controlled the amount of time the patient could pay attention. The authors

found that the attention span did not differ between AAT and controlled therapy sessions but had

a positive outcome of alertness and concentration. Furthermore, the results here demonstrated

that there was an improvement within a shorter study being six weeks compared to the first

article being twelve weeks (Gocheva, Hund-Georgiadis & Hediger, 2018). This supports the

PICOT because it is aiming for six months which is longer than both trials, and positive effects

are already being early as six weeks.

Lastly, the third article was titled, The Effect of a Pet Therapy and Comparison

Intervention on Anxiety in Hospitalized Children. This quantitative article included methods that

had a control and experimental group of 42 participants where data was collected one to two

days of each week. The control group did a puzzle for ten minutes while the experimental group
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received eight to ten-minute sessions with the animal handler team. Although the experimental

team did not find significant changes in the anxiety level between the two groups, the baseline

for each group showed significantly lower anxiety levels (Hinic, Kowalski, Holtzman & Mobus,

2019). This article supports the PICOT because the previous articles are in favor for AAT and

have shown positive effects whereas this one is not. This study determined that there were no

significant findings with the use of animals during therapy. This supports the PICOT because it

gives statistics on the opposite side of the argument. This will be helpful because it can disprove

certain aspects that other studies fail to mention.

Areas to Further Study

After analyzing all three articles that contribute evidence in support of the PICOT

question, what is known is still not concrete. What is known is two articles shared that the use of

AAT did contribute positive effects to patients with autism spectrum disorders whereas one

article counteracted that but did have slight signs of improvement. It is not known how long the

use of this therapy will be needed to help improve areas of focus, however. Things that could

enhance the study would be to include more comprehensive assessments regarding specific

behaviors in children with autism. Additionally, extending the amount of sessions and length of

them could show significant positive trends in these patients because it is hard to determine

results with trials that last for a couple of weeks or sessions. Furthermore, incorporating

additional hospitals and patients would benefit the study of the PICOT because it allows for

diversity within the autistic spectrum.

Conclusion

It is easy for people who admire animals to advocate for the use of animal assisted

therapy, however researching the effects of this intervention carries an importance in the
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advancement of autistic children’s social skills. Thus far, AAT has shown a significant positive

effect on these children but still has plenty of room for further research. In the three articles

discussed, the main points showed that there is a possibility that this therapy can be beneficial. It

is important for therapies to be explored because the number of children born with an ASD is not

rare so as nurses this PICOT can aid in finding therapies and interventions for these patients.

Therefore, when using animal assisted therapies in plans of care, this intervention seems to be a

positively emerging option.

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References

Al-Hmouz, H., & Arabiat, A. (2015). Therapeutic horseback riding and children with autism

spectrum disorders. Journal of the International Association of Special Education, 16(1),

42–50. Retrieved from https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?

direct=true&db=ehh&AN=118900050&site=eds-live&scope=site. Acesso em: 26 abr.

2020.

Gocheva, V., Hund-Georgiadis, M., & Hediger, K. (2018). Effects of animal-assisted therapy on

concentration and attention span in patients with acquired brain injury: A randomized

controlled trial. Neuropsychology, 32(1), 54–64. https://doi-

org.lopes.idm.oclc.org/10.1037/neu0000398

Hinic, K., Kowalski, M. O., Holtzman, K., & Mobus, K. (2019). The effect of a pet therapy and

comparison intervention on anxiety in hospitalized children. Journal of Pediatric

Nursing, 46, 55. Retrieved from https://search-ebscohost-

com.lopes.idm.oclc.org/login.aspx?direct=true&db=edo&AN=136345478&site=eds-

live&scope=site. Acesso em: 26 abr. 2020.

Yap, E., Scheinberg, A., & Williams, K. (2017). Attitudes to and beliefs about animal assisted

therapy for children with disabilities. Complementary Therapies in Clinical Practice, 26,

47–52. https://doi-org.lopes.idm.oclc.org/10.1016/j.ctcp.2016.11.009

Žalienė, L., Mockevičienė, D., Kreivinienė, B., Razbadauskas, A., Kleiva, Ž., & Kirkutis, A.

(2018). Short-term and long-term effects of riding for children with cerebral palsy gross

motor functions. BioMed Research International, 2018, 1–6. https://doi-

org.lopes.idm.oclc.org/10.1155/2018/4190249