Animal-assisted interventions (AAI) are goal-oriented and structured strategies that include animals in health, education, and human services for therapeutic gains (IAHAIO, 2014 http://bit.ly/2vk8gll). Human-animal interactions (HAI) are mutually beneficial and dynamic relationships between people and animals that are influenced by behaviors considered essential to the health and well-being of both. Spanning diverse areas from contact with wildlife to pet keeping and AAI, the scope of HAI includes the emotional, psychological, and physical interactions of people, animals, and the environment (American Veterinary Medicine Foundation, 2017 http://bit.ly/2vjOO8s). Notably, this human-animal bond may be harnessed for the rehabilitation of people with hearing loss and other otologic disorders.
AAI has three main categories (Fig. 1; IAHAIO, 2014 http://bit.ly/2vk8gll):
- Animal-assisted therapy (AAT): A goal-oriented and structured intervention done by qualified health, education, and human service professionals. AAT focuses on enhancing the physical, cognitive, behavioral, and/or socioemotional functioning of the recipient. Examples include equine-facilitated psychotherapy and therapeutic horsemanship.
- Animal-assisted education (AAE): It's like AAT, but involves education professionals such as teachers and special education staff. It focuses on academic goals, social or cognitive functioning, personal growth, or life skill development. Examples are dog-assisted reading programs and equine-facilitated learning.
- Animal-assisted activity (AAA): A planned but informal interaction conducted by a human-animal team, largely for motivational and/or recreational purposes. Examples include hospital and nursing home visits and programs for at-risk youth (Fine, et al. In: Fine, ed. Elsevier, 2015 http://bit.ly/2vjpUFK).
Animals have always been regarded as central players in the treatment of human illnesses, starting with their role as guardian spirits. The ancient Greeks conceived of a therapeutic partnership between horses and humans (Animal Frontiers. 2014;4:72 http://bit.ly/2vjV6ou). However, the notoriety of animals as healers of disease took a sinister turn as Christianity swept across the modern world. The witch hunts of Europe between the 15th and 17th centuries saw animal companions (pets) designated as occultist “familiars” (Serpell. In: Fine, ed. Elsevier, 2015 http://bit.ly/2vkfIgw). Thankfully, the Age of Enlightenment brought with it an awareness of the beneficial socializing function of animals, so that by the 19th century, animals were common inhabitants of institutionalized care facilities. It was at this point that early experiments began, with the first known study examining the effects of horse riding on people with disabilities appearing in 1870 (Animal Frontiers. 2014 http://bit.ly/2vjV6ou).
However, the advent of modern, “rigorous” science soon consigned further AAI study to the ether. It would not be until the seminal psychotherapy papers of Levinson in 1969, along with Corson and O'Leary in 1975 that the therapeutic benefits of human-animal interactions would again capture academics (Serpell. In: Fine, ed. Elsevier, 2015 http://bit.ly/2vkfIgw). With these notable works, the field of animal-assisted therapy commenced a measured ascent. Most recently, interest has been piqued by meticulous publications on the positive effects of AAI on physiologic stress responses, such as reduced heart rates, increased oxygen saturation, and suppressed elevated cortisol levels (Friedmann, et al. In: Fine, ed. Elsevier, 2015 http://bit.ly/2vjKwhc).
AAI IN AUDIOLOGY
To date, audiology has made a single foray into the realm of AAI and it is a tenuous link at best. Some audiologists and hearing health professionals may have had clients accompanied by service dogs, or may have worked with dog trainers in awareness programs on hearing impairment and deaf culture. In the United States, there are legislated requirements to train service animals, as well as laws in place on public, transportation, and housing access. “Hearing dogs” aid people with hearing loss by alerting them to a variety of environmental sounds, such as a door knock, alarm clock, oven timer, telephone ring, baby cry, name call, or smoke alarm (Fig. 2). These dogs are trained to make physical contact and lead their human partners to the sound source (ADI, 2017 http://bit.ly/2wnhagr). Hearing dogs also give their handlers a sense of safety, confidence, and independence. They help alleviate loneliness, thus promoting social participation of their handlers. However, perusal of the literature reveals limited academic investigation of this activity.
The audiologist's mantra of rehabilitation is to maximize use of residual hearing, reduce activity limitations, eliminate participation restrictions, and ultimately improve quality of life for clients with hearing loss. Audiologists too must remain focused on the essential link between hearing and communication, and cognizant of the diverse stressors at play in the minds and lives of those with hearing impairments.
For these very reasons, it would seem within the scope of our profession to consider AAI applications in the rehabilitation of clients with hearing loss and/or other otologic disorders. While more evidence is needed to empirically demonstrate the unique therapeutic effects of AAI on people with hearing loss, other disciplines—anthrozoology, equine science, veterinary science, psychology, and education—show the rehabilitative strengths of this approach. AAT practitioners and clients themselves are vital contributors. By introducing animals as co-therapists in the rehabilitation equation, only multidisciplinary research of the highest standards can produce convincing evidence.
Several audiological client groups could potentially benefit from structured therapeutic interactions with animals, such as:
- Central auditory processing disorder (CAPD):
- Involving canines to prime pediatric clients prior to/during therapy to improve psychosocial well-being, boost engagement, and enhance client-clinician interaction.
- Involving equines in a therapeutic riding curriculum to address cognitive deficits in processing.
- Involving canines in therapy for children with autism to exploit benefits associated with the shared sensory style of cognition of both parties.
- Tinnitus and hyperacusis with/out hearing loss:
- Involving equines in therapy to reduce occurrence/symptom severity.
- Otolaryngology surgeries:
- Involving canines to reduce pre-operative stress in children and families prior to cochlear implantation and other surgical interventions.
- Young adults with hearing loss:
- Involving equines in facilitated learning to target self-awareness, personal growth, resilience, and socialization.
- Communication therapy in children with hearing loss:
- Involving equines or canines to enhance engagement, rapport, and stress reduction.
- Balance disorders:
- Involving equines in hippotherapy or therapeutic riding programs (Fig. 3).
It remains to be seen whether AAI can be employed to improve the lives of those with hearing loss and/or other otologic disorders. What is certain, however, is that the gulf between the widespread public belief in AAI and empirical evidence can only be lessened by the contribution of rigorous and well-designed studies. As noted by Herzog, research methodology in AAI will need to step up its game and address numerous threats to the validity of investigations, including the replication crisis in science, the “file drawer” phenomenon, sample and effect size issues, the unfortunate spinning of results, and researcher bias (Fine. Elsevier, 2015 http://bit.ly/2vk2i3Z).
Nonetheless, proponents of the biophilia hypothesis expect to see positive outcomes from such earnest and scholarly studies. These theorists espouse that our brains are predisposed to selectively pay attention to all living things in the environment; therefore, contact with other animal species and even plant life may influence our health, well-being, and cognition (Fine, et al. In: Fine. Elsevier, 2015 http://bit.ly/2vjpUFK). By connotation, hearing health professionals and patients should be self-interested in engaging in therapeutic activities that include a naturalistic element.