Abstract
Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings from the systematic review on the effectiveness of animal-assisted therapy to improve arousal and awareness for people with disorders of consciousness following a traumatic brain injury.
Full Systematic Review Question
This systematic review addressed the question “What is the evidence for the effectiveness of interventions to improve arousal and awareness for people in a disordered state of consciousness post TBI?”
Current Theme Reported
The main theme of the article included in this systematic review brief is animal-assisted therapy.
Clinical Scenario
More patients are surviving a traumatic brain injury (TBI) because of improvements in early resuscitation, interventions, and rehabilitation (Claassen et al., 2021). Increased survival is evident for patients with disorders of consciousness (DoC) following a severe TBI. DoC diagnoses include comatose, vegetative state/unresponsive wakefulness syndrome, and minimally conscious state (MCS). Neurobehavioral function outcome measures may include items that capture whether a patient has emerged from MCS. Recent practice guidelines recommend practitioners use standardized neurobehavioral assessment measures to improve diagnostic accuracy for disordered states of consciousness, identify trends in the patient’s recovery trajectory, and have effective rehabilitation care (Giacino et al., 2018). Evidence demonstrates that patients can experience meaningful functional recovery 5- and 10-yr postinjury (Hammond et al., 2019; Whyte et al., 2013). We provide the current evidence about interventions that can be provided by occupational therapy practitioners as part of treatment plans for adults with DoC. This systematic review brief focuses on animal-assisted therapy (AAT) interventions.
Summary of Key Findings
One study that used AAT intervention met the criteria for inclusion in this systematic review (Table 1). The levels of evidence used in this review are from Oxford Centre for Evidence-Based Medicine (2009).
Evidence Table for Animal-Assisted Interventions to Improve Arousal and Awareness for People in a Disordered State of Consciousness Post TBI
Note. AAT= animal-assisted therapy; ABI = acquired brain injury; TBI = traumatic brain injury.
Bottom Line for Occupational Therapy Practice
Occupational therapy practitioners treat individuals with DoC to facilitate arousal and awareness and use a variety of treatment modalities to support recovery of consciousness in individuals with DoC. In this review, only one study that examined AAT as a treatment modality was included. Although the authors noted changes in selected behavioral responses of participants during AAT sessions using the Basler Vegetative State Assessment, there were no changes reflecting a change in level of consciousness. Use of an animal during therapy sessions for patients with DoC may increase specific behavioral responses (i.e., eye movements and phonation); however, the use of AAT requires further assessment to determine 1) its effect on level of consciousness and 2) how the effects of AAT compare with standard of care. AAT has the potential to engage patients with DoC in a therapeutic intervention that facilitates interactions with an animal in the patient’s immediate surroundings that, depending on the person’s occupational profile, is meaningful and client centered. Therefore, occupational therapy practitioners could consider using AAT, if animals are meaningful to their patient, as part of a comprehensive plan of care for patients with DoC.
Footnotes
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Indicates articles included in the systematic review brief.