The effects a rehabilitation dog has on walking balance and fear of falling in individuals with an incomplete spinal cord injury
Date
2023-02-03
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ORCID
Type
Thesis
Degree Level
Masters
Abstract
BACKGROUND: Individuals with an incomplete spinal cord injury (iSCI) may experience gait instability and falls. Falls can result in injuries, a fear of falling, and reduced balance confidence which can lead to restriction of activities of daily living. Rehabilitation dogs are specially trained and certified to assist individuals with mobility impairments and have been shown to benefit walking for individuals with neurological conditions. The effects of a rehabilitation dog on walking, fear of falling, and balance confidence in individuals with an iSCI has yet to be assessed.
METHODS: In this quasi-experimental research study, five individuals with an iSCI (3 females: 43-54 years; 2 males: 42-69 years) and five age- and sex- matched neurotypical individuals (control group: 3 females: 42-55 years; 2 males: 42-68 years) were recruited to participate. Participants completed normal and tandem walking trials, with and without the rehabilitation dog, while their eyes were open and closed. Outcome variables included stride velocity, relative double support time (%DS), step length, step width, mediolateral (ML) and anterior-posterior (AP) margin of stability (MOS) average (Av). Variability was assessed for all the outcome variables using standard deviation (SD). The Mini Balance Evaluation Systems Test (MiniBESTest), Activity Specific Balance Confidence Scale (ABC Scale), Falls Efficacy Scale – International questionnaire (FES-I), and additional questions added to the ABC and FES-I questionnaire were used to examine balance, balance confidence, and fear of falling, respectively. Visual analog scales (VAS) were included to measure participants’ perceptions of walking with the rehabilitation dog.
RESULTS: Without the rehabilitation dog, participants with iSCI walked slower and with shorter steps, a smaller AP MOS Av, and a higher %DS, %DS SD, and wider steps than controls. It appeared individuals with an iSCI showed some improvements with the rehabilitation dog while the control group showed worsening when the dog was added. For iSCI participants, the rehabilitation dog reduced the impact of the eyes closed condition while walking compared to without the rehabilitation dog by decreasing their %DS (mean and SD) to a value similar to controls.. Tandem walking with the rehabilitation dog resulted in similar AP MOS Av between groups, but overall, the rehabilitation dog had minimal impact on tandem walking. The group with iSCI had a lower balance control (iSCI 17.2±9.34, control 26.8±0.80), balance confidence (iSCI 67.6±15.3, control 92.4±2.78), and increased fear of falling (iSCI 28.6±7.16, control 20.6±1.51) compared to the control group as expected. Responses to the additional questions for the ABC and FES-I suggest walking with the rehabilitation dog improved balance confidence and decreased fear of falling for individuals with an iSCI. VAS results showed both groups felt subjective improvements walking with the rehabilitation dog.
CONCLUSION: Walking with the rehabilitation dog appeared to improve measures of gait and confidence in the participants with iSCI including objective (kinematic) and patient-reported outcomes. Further research is required with a larger number of participants to explore how a more experienced rehabilitation dog walk with an iSCI population and other neurological conditions.
Description
Keywords
Spinal cord injury, biomechanics, rehabilitation dog, fear of falling, balance control, walking, tandem walking
Citation
Degree
Master of Science (M.Sc.)
Department
Kinesiology
Program
Kinesiology