RESEARCH

Efficacy of Animal-Assisted Therapy in Treatment of

Patients With Traumatic Brain Injury: A Randomized Trial
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Leslie Horton, MBA, RN, CCRN-K, C-AAIS, IACP CDT, CDTA, PDTI, CSDT 
Margaret Griffen, MD, FACS  Lui Chang, PhD  Anna B. Newcomb, PhD, MSW, LCSW

BACKGROUND: Severe traumatic brain injury carries major public health consequences, with patients suffering long-term disability
with physiological, cognitive, and behavioral changes. Animal-assisted therapy, the use of human and animal bonds
in goal-directed interventions, has been a suggested therapy, but its efficacy in acute brain injury outcomes remains
unknown.
OBJECTIVE: This study aimed to assess animal-assisted therapy’s effects on cognitive outcome scores of hospitalized severe
traumatic brain-injured patients.
METHODS: This single-center, randomized, prospective trial was conducted from 2017 to 2019 and examined the effects of
canine animal-assisted therapy on the Glasgow Coma Scale, Rancho Los Amigo Scale, and Levels of Command of
adult severe traumatic brain-injured patients. Patients were randomized to receive animal-assisted therapy or usual
standard of care. Nonparametric Wilcoxon rank sum tests were used to study group differences.
RESULTS: Study patients (N = 70) received 151 sessions with a hander and dog (intervention, n = 38) and 156 without (control,
n = 32) from a total of 25 dogs and nine handlers. When comparing the patients’ response during hospitalization to
animal-assisted therapy versus control, we controlled for sex, age, baseline Injury Severity Score, and correspond-
ing enrollment score. Although there was no significant change in Glasgow Coma Score (p = .155), patients in the
animal-assisted therapy group reported significantly higher standardized change in Rancho Los Amigo Scale (p =
.026) and change commands (p < .001) compared with the control group.
CONCLUSIONS: Patients with traumatic brain injury receiving canine-assisted therapy demonstrated significant improvement com-
pared with a control group.
KEY WORDS: Animal-assisted therapy, Canine-assisted therapy, Severe traumatic brain injury
Cite as: Horton L., Griffen M., Chang L., Newcomb A. B. (2023). Efficacy of animal-assisted therapy in treatment of patients with traumatic brain injury:
A randomized trial. Journal of Trauma Nursing, 30(2), 68-74. https://doi.org/10.1097/JTN.0000000000000705

Dates: Submitted August 9, 2022; Revised December 14, 2022; Accepted
December 15, 2022.
Author Affiliation: Inova Fairfax Medical Campus, Falls Church, Vir-
ginia.
Margaret Griffen is currently with University of Kentucky.
The following participants had a role in the drafting of the study and/
or the data collection of the study: Elena Jacobsen, Alicia Landis, Ruth
Ann Harrold, and Stacey Harris assisted with research proposal and
data collection; Jeffrey Horton conducted statistics and data analysis
on research data; and bedside RNs of TICU, TIMCU, and TACS com-
pleted observations and data collection sheets.
Leslie Horton’s company, Most Fine Canine, Inc, is on contract with
Inova Health Systems for the coordination and management of the
Animal-Assisted Care Program since 2000. To prevent unintentional
bias for data collection, data collection forms were completed by the
bedside RNs.
ClinicalTrials.gov identifier NCT05217030.
The authors declare no conflicts of interest.
Supplemental digital content is available for this article. Direct
URL citations appear in the printed text and are provided in the
HTML and PDF versions of this article on the journal’s Web site
(WWW.JOURNALOFTRAUMANURSING.COM).
Correspondence: Leslie Horton, MBA, RN, CCRN-K, C-AAIS, IACP
CDT, CDTA, PDTI, CSDT, Inova Fairfax Medical Campus, 3300 Gallows
Road, Room PG-147, Falls Church, VA 22042 (Leslie.Horton@inova.
org).
BACKGROUND
Traumatic brain injury (TBI) is a serious public
health concern, with nearly 3 million emergency de-
partment visits annually. With an estimated 2.5 million
people in the United States suffering a TBI each year, the
associated cost is $76.5 billion for care and loss of pro-
ductivity. Traumatic brain injury is categorized as mild,
moderate, severe, and profound based on the Injury Se-
verity Score (ISS) (Javali et al., 2019). Patients with TBI
can have significant decreases in level of consciousness,
thus interfering with their ability to (1) actively partici-
pate in recovery, (2) obtain adequate nutritional input,
and (3) follow commands to increase range of motion
and physical strength and often require long hospital-
izations (Chan et al., 2021).
Confusion occurs within the media and research
regarding the terms to use for therapy animals, their
interactions, and service dogs (Lovell & Ranse, 2022;
Stapleton, 2016). The U.S. Department of Justice de-
fines service dogs as those trained to perform tasks to
mitigate disability symptoms. Therefore, the service
dog is not considered a pet or a therapy animal but is

68 Journal of Trauma Nursing 2023

Volume 30, Number 2
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 Journal of Trauma Nursing 2023 Horton et al.
Volume 30, Number 2

The study examined the effects of canine animal-assist-

KEY POINTS
ed therapy on the Glasgow Coma Scale (GCS), Ran-
• Traumatic brain injury (TBI) is costly, requiring new
strategies.
cho Los Amigo Scale (RLAS), and Levels of Command
(LOCmd) of adult severe traumatic brain-injured pa-
• An innovative TBI strategy is animal-assisted therapy.
tients. Patients were randomized to receive animal-as-
• TBI animal-assisted therapy improves patients’ sisted therapy or usual standard of care. The study con-
cognitive abilities with improvements seen in the
formed with the CONSORT guidelines (Moher et al.,
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Glasgow Coma Scale, Rancho Los Amigos Scale, and

ability to follow commands. 2010), and the study was approved by the Inova Health
• Trauma centers should consider animal-assisted therapy
System’s Institutional Review Board (#12-1216).
as a health care modality.
Program Development
Our Animal-Assisted Care Program was devel-
considered similar to a piece of medical equipment and
oped and proposed by an experienced trauma intensive
can accompany its disabled handler into public environ-
care unit (ICU) nurse who served as Animal-Assisted
ments (see Definition of Terms, Supplemental Digital
Care Coordinator. A wide variety of disciplines may in-
Content 1, available at: http://links.lww.com/JTN/A84).
corporate animal-assisted therapy, including physicians,
Therapy animals can be various domestic pet species
occupational therapists, physical therapists, certified
and are usually credentialed by a therapy organization,
therapeutic recreation specialists, nurses, social work-
such as Pet Partners, Therapy Dogs Inc. The handler
ers, speech therapists, or mental health professionals.
and the pet receive approval from organizations such
Examples of how our program uses animal-assisted
as hospitals, schools, and prisons to provide animal-
therapy include encouraging a patient with a decreased
assisted interactions
level of consciousness to open their eyes or to follow
Animal-assisted interactions are goal-oriented,
commands; having a dog lie beside a terminally ill pa-
structured interventions intentionally incorporating
tient who is active in the dying process; having the pa-
animals in health, education, and human service for
tient throw or kick a ball to the dog to increase strength
therapeutic gains and improved health and wellness
in extremities; having a dog present to decrease prepro-
(Lovell & Ranse, 2022). In our institution, services are
cedure, intraprocedure, and postprocedure stress.
available to patients when physicians or advanced li-
The goal of the proposed program was to use an-
censed practitioners write orders for patients to be con-
imal-assisted therapy to improve patient recovery. The
sidered in the Animal-Assisted Care Program. Clinicians
nurse presented the proposal to a supportive hospital ad-
assess and arrange for one of four types of animal-as-
ministration and a board of directors, who approved the
sisted interactions: animal-assisted activity, animal-as-
proposal as a pilot on the oncology and neurology units
sisted therapy, personal assistance therapy, and own pet
in March 2000. The program coordinator worked with
interaction. This study focused particularly on animal-
leaders, staff, infection prevention, risk management,
assisted therapy, a planned, goal-oriented, structured,
and medical records to develop policies and procedures
and documented therapeutic intervention directed by
reflecting best practices for animal-assisted interactions.
health and human service providers as part of their pro-
A physician or advanced practice provider order was re-
fessions (Lovell & Ranse, 2022).
quired for animal-assisted patient interactions, and all
patient responses were documented in the medical re-
cord. Following extensive staff education, the Animal-
OBJECTIVE
Assisted Care Program was launched in December 2000.
This study aimed to assess the effects of animal-
assisted therapy on cognitive outcome scores of hos- Patient Enrollment
pitalized severe traumatic brain-injured patients. We We recruited adult patients admitted to the trauma
hypothesized that the subjects in the animal-assisted ICU with moderate to profound TBI; patients’ legally
therapy group would achieve higher elevations in cog- authorized representatives provided consent for patients
nitive ability than those in the control group. to be randomized into an intervention or control group.
Patients were randomized to the intervention or control
group in a 1:1 ratio; the randomization schedule was
METHODS
generated in advance by the study biostatistician utiliz-
This single-center, randomized, prospective trial ing a permuted block method with block sizes of two or
was conducted from 2017 to 2019 in a Level I trauma four (see Figure 1). Study subjects’ assigned groups were
center with an estimated admitted trauma volume of indicated on paper in a sealed envelope opened by the
2100–2200 patients per year. The trauma center is near researchers upon receipt of a signed informed consent
a large metropolitan city in the eastern United States. form. Adult English or Spanish-speaking patients were


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 Horton et al.
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Figure 1. CONSORT flow diagram.
eligible when admitted to the trauma ICU with TBI as
identified by a GCS of 10 or less upon admission to the
emergency department.
Traumatic brain injury was verified via radiology
and trauma surgeon review of head computed tomogra-
phy scan or magnetic resonance imaging. Patients with
dog allergies, isolation precautions, previous diagnosis
of dementia, or determined to have a blood alcohol
level greater than 0.8 mg/dl with no evidence of a TBI
were excluded. Because patients presented with a GCS
of 10 or less, they were intubated before or on arrival
to the emergency department. However, due to cultures
pending, procedures, or sensitivities pending, seven
of the animal-assisted therapy group and five of the
controlled group received their initial animal-assisted
therapy without being intubated or sedated. Patients in
the animal-assisted therapy group had animal-assisted
therapy completed even if they were sedated, intubated,
or in wrist restraints for safety (restraints were loosened
so the patient’s hand could be placed on the dog’s fur).
Sample Size
Due to associated costs with translations of
informed consent, we assessed the previous year’s
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Journal of Trauma Nursing 2023
Volume 30, Number 2
admissions of patients with the primary language of
English or Spanish admitted with TBI. Power calcu-
lation was based on a two-sided two-sample t test to
detect significant changes in the primary outcomes. It
was calculated that 80 subjects (40 subjects per group)
would achieve 80% power with a type I error rate of
0.05, assuming a moderate effect size of 0.65. Difficulty
obtaining written consent due to the location of sig-
nificant others and limitation to English and Spanish-
speaking patients attributed to smaller sample sizes.
Assessment Measures
On admission to the study, the primary, second-
ary, and tertiary types and locations of TBI; GCS, RLAS,
and LOCmd scores on admission to the emergency de-
partment and the trauma ICU; and extremity movement
or injury were recorded within 24 hr of consent (see
Admission to Study Data Collection Sheet, Supplemen-
tal Digital Content 2, available at: http://links.lww.com/
JTN/A85). The GCS is used initially to assess whether
impaired consciousness exists and to define its extent
(Mehta & Chinthapalli, 2019). The RLAS describes the
cognitive and behavioral status and is commonly paired
with the GCS in the beginning of trauma assessment
Copyright © 2023 Society of Trauma Nurses.
 Journal of Trauma Nursing 2023
Volume 30, Number 2
but is also used throughout the recovery process for TBI
(Ponsford et al., 2021). The LOCmd was determined by
the number of commands a patient could follow with-
out prompting in between the commands. Subjects un-
able to follow any commands scored “0”; those able
to follow one command scored “1,” and so on, up to 3
commands without prompting. The higher the level of
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following commands, the stronger cognitive function is
at that time (Hammond et al., 2019).
Data Collection Steps
Intervention patients received measurements of
the GCS, RLAS, and LOCmd immediately before an-
imal-assisted therapy with a dog, followed by the col-
lection of postintervention scores (see Data Collection
Tool, Supplemental Digital Content 3, available at:
http://links.lww.com/JTN/A86). The bedside nurse as-
sisted the handler in placing the dog onto the patient’s
bed, and the patient was informed the dog was pres-
ent. The patient’s hand was placed on the dog, and then
the patient was instructed to open their eyes and follow
commands. The bedside nurse assessed and recorded
the patient’s responses before and after each animal-
assisted interaction.
Control patients had scores assessed immediately
before the researcher entered the room and again after
the researcher sat in the room without engaging the pa-
tient. The bedside nurse assessed and recorded the pa-
tient before and after each control intervention.
The length of stay was intended to be included in
the data collection but was found to be difficult to mea-
sure accurately. Both groups had patients with extended
stays due to waiting for available beds on trauma step-
down or surgical units and then again when waiting for
available beds in rehabilitation or skilled nursing centers.
Animal-assisted therapy and control activities,
and associated data collection continued every Monday,
Wednesday, and Friday following initial measurements.
Subjects remained enrolled in the study through dis-
charge, or until the subject was recorded at RLAS 7, or
until hospitalized over 28 days. Patients discharged from
the study but remaining in the hospital could continue
receiving animal-assisted therapy. The study enrollment
was completed on December 31, 2019, as we had com-
pleted our approval time for the study per the institu-
tional review board and had a reliable sample size.
Statistical Analysis
The primary outcome measures were the GCS,
RLAS, and LOCmd scores. Postintervention changes
in each score from preintervention were summarized
and compared using the Wilcoxon rank sum test. In
addition, frequencies and percentages of subjects with
improved scores were summarized and compared us-
ing Fisher’s exact test. Baseline characteristics were

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Horton et al.
summarized descriptively, including age, sex, ISS, GCS,
RLAS, and LOCmd at enrollment. Linear mixed mod-
els for each outcome were estimated, using standardized
changes in scores as dependent outcomes. Treatment
group, age, sex, head-specific Abbreviated Injury Scale
(AIS), and corresponding score at enrollment were used
as covariates and random intercepts for each subject.
Generalized estimating equations were used to obtain
parameter estimates. All analyses were performed using
R, Version 4.1.2 (R Core Team, Vienna, Austria).
RESULTS
Demographics
Seventy subjects were enrolled in the study, with
a median (interquartile range [IQR]) age of 46.5 years
(28–68), including 50 male and 20 female patients
(Table 1). Nine handlers with 25 different dogs engaged
subjects in 151 therapy sessions with 38 intervention
subjects (Table 2); research team members engaged in
156 noninterventions with 32 control subjects. Animal-
assisted therapy handlers brought dogs of 10 different
breeds, with the most popular breeds being Labrador
Retrievers and mixed. Handlers and dogs were rotated
among the enrolled patients.
The ISS of enrolled patients ranged from less
than 9 to 25 or more. The majority of subjects, n = 43
(61%), were profoundly injured, with an ISS of 25 or
more; the remaining 20, n = 20 (29%), were admitted
with an ISS of 16–24 and seven (10%) with an ISS of 15
or less. Entry to study GCS ranged from 3 to 11, with n
= 32 (45%) having a GCS of 8–10 and n = 14 (20%)
with a GCS of 6. Only nine subjects (12%) were able to
follow any commands upon enrollment; those subjects
responded only to one command, “move your fingers,”
but not three-step commands as defined as LOCmds,
such as “move your fingers then move your toes.” In
both groups, the type of TBIs was combined subdural
hematomas and subarachnoid hemorrhages. No signifi-
cance was noted in the different types of TBI between
the two groups.
Of the 70 enrolled subjects, 12 died in the hospi-
tal due to the severity of their injuries. The intervention
and control groups were statistically similar regarding
age, ISS, RLAS, GCS, and LOCmd at enrollment. The
animal-assisted therapy group had a higher overall me-
dian (IQR) ISS of 27 (24–34) compared with the con-
trol group—24.5 (24–34), p = .038. The median (IQR)
head-specific AIS was comparable between the two co-
horts; 4 (3–5) for both cohorts (p = .613).
Outcomes
For the primary outcomes, results demonstrat-
ed statistically significant differences in the median
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Table 1. Demographics and Baseline Patient and Therapy Dog Characteristics

Total (n = 70) Control (n = 32) AAT (n = 38) p
Sex .008
Female, n (%) 20 (28.57%) 4 (12.5%) 16 (42.11%)
Male, n (%) 50 (71.43%) 28 (87.5%) 22 (57.89%)
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Age, M (SD), year 46.5 (28– 60) 47 (27.75–58.5) 46.5 (28.5–60) .8

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ISS, Mdn [IQR] 26 [20–30] 24.5 [18.5–29] 27 [24–34] .038

<9 3 (4.29%) 2 (6.25%) 1 (2.63%)
9–15 4 (5.71%) 2 (6.25%) 2 (5.26%)
16–24 20 (28.57%) 12 (37.5%) 8 (21.05%)
≥25 43 (61.43%) 16 (50%) 27 (71.05%)
Head AIS 4 [3–5] 4 [3–5] 4 [3–5] .613
RLAS at enrollment 2 [2–3] 3 [2–3] 2 [2–3] .584
LOCmd at enrollment 0 [0–0] 0 [0–0] 0 [0–0] .434
Number of sessions 4 [2–6.75] 4 [2–7] 4 [2–6] .576
Dog Characteristics (N = 25)a
American Staffordshire Terrier 1 German Shepherd 2
Bichon Frise 1 Golden Retriever 2
Cairn Terrier 1 Italian Greyhound 1
Chihuahua 2 Labrador Retriever 7
Dachshund 1 Mix breed 7
Note. AAT = animal-assisted therapy; AIS = Abbreviated Injury Scale; IQR = interquartile range; ISS = Injury Severity Score; LOCmd = Levels of Command; RLAS = Rancho Los Amigos Scale.
Nine handlers participated in the study; some handlers had more than one dog.
a

postintervention score change between animal-assisted therapy group demonstrated this ability following
therapy and the control by the Wilcoxon rank sum interventions.
test; however, all resulting medians (IQRs) were zeros When comparing the treatment effect of animal-
(Table 3). Furthermore, considering the frequencies assisted therapy versus control while controlling for
and percentages of subjects with improved scores, sig- sex, age, baseline ISS, and corresponding enrollment
nificantly higher percentages reported improved scores score, we found no significant difference between
post-intervention for all three outcomes (Table 2). animal-assisted therapy and control in changed GCS
Additionally, although no patients in the control (p = .155); however, patients in the animal-assisted
group demonstrated an ability to follow multistep therapy group reported significantly higher standard-
commands during the study, 18 of the animal-assisted ized changed RLAS (p = .026) and changed LOCmd
(p < .001) compared with the control group (Table 3).
It is important to note the p value for change in GCS
Table 2. Pre-/Post-Medians and IQRs for GCS, RLAS, without controlling for sex, age, baseline ISS, and
and LOCmd corresponding enrollment score did show significance
Control AAT p in change. However, with controls for these variables,
Change GCS 0 [0–0] 0 [0–0] .059 change in GCS was determined to be nonsignificant.
None of the other covariates were significant from the
Change RLAS 0 [0–0] 0 [0–0] .007
linear mixed models.
Change LOCmd 0 [0–0] 0 [0–0] <.001
Frequencies and Percentages of Improvements in Patients Post-Session
DISCUSSION
Change GCS 2 (1.32%) 14 (8.97%) .003
Change RLAS 1 (0.66%) 12 (7.69%) .003
Since the start of the pilot Animal-Assisted Care
Program in 2000, the team has conducted more than
Change LOCmd 0 (0%) 18 (11.54%) <.001 39,000 interventions for over 14,000 patients. The
Note. AAT = animal-assisted therapy; GCS = Glasgow Coma Scale; IQR = interquartile program has arranged over 1,200 interactions with
range; LOCmd = Levels of Command; RLAS = Rancho Los Amigos Scale.
patients’ own pets for long-term or terminally ill

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 Journal of Trauma Nursing 2023
Volume 30, Number 2
Table 3. Results of Linear Mixed Model: Change GCS, Change RLAS, and Change LOCmd
Change GCS
Estimate [95% CI]
AAT vs. control 0.18 [−0.07, 0.43]
Sex (male vs. female) 0.07 [−0.21, 0.36]
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Age 0.01 [0, 0.01]
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Head-specific AIS −0.05 [−0.18, 0.08]
Enrollment scorea −0.01 [−0.07, 0.06]
Note. AAT = animal-assisted therapy; AIS = Abbreviated Injury Scale; CI = confidence interval; GCS = Glasgow Coma Scale; LOCmd = Levels of Command; RLAS = Rancho Los Amigos Scale.
GCS, RLAS, and LOCmd enrollment scores were used in their respective models.
a
patients and has seen nearly 2,000 patients in neu-
tropenic precautions. In 2005, the Animal-Assisted
Care Program began work in critical care units; 35%
of program interventions each year have occurred in
these units. Health care team members and animal-
assisted care team handlers noted increases in Level of
Consciousness (LOC) and responses of unconscious
patients during animal-assisted therapy, prompting
the team to initiate this current study.
Most acute care settings offering animal-assisted
interactions use volunteer programs to provide these
interventions. However, most volunteer programs only
offer animal-assisted activities and not animal-assisted
therapy. Animal-assisted therapy, by definition, requires
licensed professionals to coordinate and evaluate the
patient’s response. Coordinators must be knowledge-
able in canine behavior, prevention of transmission of
zoonotic infections, and proper selection, implementa-
tion, and evaluation of animal-assisted therapy inter-
ventions to assist the patients in recovery.
Many studies note that animal-assisted therapy
improves mood, decreases stress, and has resulted in pa-
tients reporting lower pain levels; animal-assisted thera-
py has been found useful in ICU patients as an adjunct
to sedative and analgesic medications to improve psy-
chological symptoms and promote comfort, relaxation,
and positive mood in mechanically ventilated patients
(Hosey et al., 2018; Tracy & Chlan, 2011).
Two studies have shown that patients in the post-
TBI recovery phase have reported increased mood and
participation in rehabilitation activities (Künzi et al.,
2022; Stapleton, 2016). In another randomized con-
trolled study, therapists documented perceived increases
in concentration and attention span in patients receiv-
ing animal-assisted therapy during rehabilitation ther-
apy sessions with speech, physiotherapy, and occupa-
tional therapy (Gocheva et al., 2018). Two other studies
revealed self-reported patient and family satisfaction
using animal-assisted activities in acute care settings
(Lovell & Ranse, 2022; Stevens et al., 2017).
Although these studies are intriguing, few stud-
ies quantitatively address the use of animal-assisted
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Horton et al.
Change RLAS Change LOCmd
p Estimate [95% CI] p Estimate [95% CI] p
.155 0.38 [0.05, 0.71] .026 0.36 [0.15, 0.57] <.001
.616 0.2 [−0.11, 0.51] .216 −0.32 [−0.75, 0.11] .15
.119 0 [−0.01, 0.01] .47 0 [−0.01, 0] .259
.472 −0.09 [−0.27, 0.09] .328 −0.09 [−0.21, 0.04] .183
.862 −0.03 [−0.16, 0.11] .682 0.51 [−0.35, 1.37] .248
therapy in ICU patients. One found patients with con-
gestive heart failure using therapy dogs ambulated
twice the distance of the patient group that did not use
therapy dogs (Abate et al., 2011). In another, patients
with advanced heart failure who received a visit from
an animal-assisted interactions team had lower cardio-
pulmonary pressures, neurohormone levels, and anxiety
levels than patients visited only by volunteers (Cole &
Gawlinski, 2000).
Our study demonstrates that despite higher ISS in
the animal-assisted therapy group, intervention patients
achieved higher recovery scores than control patients,
as identified by postintervention RLAS, GCS, and abil-
ity to follow commands. Furthermore, improvements
in the cognitive ability of the animal-assisted therapy
group, as demonstrated by the patient’s ability to follow
multistep commands, were recorded only in the inter-
vention group. It is important to note the achievement
of higher RLAS and LOCmds is often used to determine
the placement of patients with TBI post-hospitalization.
Despite our program’s demonstrated benefits
and strong support, the provision of animal-assisted
interactions and the implementation of Animal-Assisted
Care Program more widely may be limited by a lack
of knowledge regarding the applications of animal-
assisted interactions or a resistance to order animal-
assisted interactions due to perceived zoonotic infection
risks. One study following the guidelines for Animals in
Healthcare Facilities by the Association of Professionals
in Infection Prevention Murthy et al., 2015 for conduct-
ing animal-assisted interactions resulted in zero trans-
mission of methicillin-resistant Staphylococcus aureus,
vancomycin-resistant enterococci, and Clostridium dif-
ficile (Aldaghlas et al., 2010). Additionally, health care
organizations support the low cost associated with the
volunteer provision of animal-assisted activity instead
of the cost associated with hiring a licensed provider for
animal-assisted therapy.
More research studies demonstrating the quan-
titative benefits of animal-assisted therapy are needed
to determine short- and long-term cost benefits to the
establishment and use of animal-assisted therapy versus
 Horton et al.
animal-assisted activity. Further study of animal-assist-
ed therapy in patients with TBI should include research
variables such as ICU and acute care hospital length of
stay, placement post-hospitalization, and long-term pa-
tient outcomes.
LIMITATIONS
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sIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 03/24/2024
Our results may have been underpowered due to
enrollment challenges. We encountered difficulty engag-
ing legally authorized representatives for many other-
wise eligible patients, and many patients with severe
TBI were admitted with unsurvivable injuries.
Due to the possible zoonotic spread of disease, en-
rolled patients in the animal-assisted therapy group with
cultures pending or susceptibilities of cultures pending
were held from animal-assisted therapy until the results
were provided. The control group was not affected.
If the patients in the animal-assisted therapy group
or the control group were placed into contact or droplet
isolation precautions, the data up to the point of the isola-
tion were included, and no data were collected after that
point. This occurred in only two of our enrolled patients,
and they were both in the animal-assisted therapy group.
CONCLUSIONS
The head AIS in both groups was equal. How-
ever, patients in the animal-assisted therapy group had
significantly higher multitrauma ISS. While controlling
for variables, the animal-assisted therapy group ex-
perienced significant increases in RLAS and LOCmds
than the control group. As demonstrated in these re-
sults, there is a need for acute care hospitals to recog-
nize animal-assisted interactions not only as a patient
satisfaction tool but as a health care modality using
animal-assisted therapy to improve our patients’ overall
health care outcomes.
Orcid iDs
Leslie Horton https//orcid.org/0000-0002-8975-6167
Margaret Griffen https//orcid.org/0000-0002-5327-4086
Lui Chang https//orcid.org/0000-0002-0219-959X
Anna B. Newcomb https//orcid.org/0000-0003-2869-0958
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