'Assistance dog' is a term defining a diverse range of dogs that have undergone training which allows them to help and support their owner who has a disability (Assistance Dogs International Inc., 2006). These animals perform a variety of tasks for their owners, depending on their role and their owner’s disability (Equality and Human Rights Commission, 2017).
Among the general public there is a lack of understanding around assistance dog terminology. Those in the industry use widely accepted terms, however, these terms may not be understood by the layperson. Many charitable organizations, such as Assistance Dogs International, have promoted the use of correct terminology in an endeavor to clear up misconceptions about disabilities and assistance dogs (Parenti et al., 2013). The vocabulary used in this essay will be derived from articles and guides on assistance dog law in the UK and abroad - I intend to discuss the diversity of types, uses and benefits of assistance dogs to highlight their impact on society.
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History of Usage
Perhaps the earliest documented depiction of an assistance dog is that of a painting from 79AD found in Pompeii portraying a dog guiding a blind man (Fishman, 2003). In Germany, beginning in 1916 after the First World War, German Shepherd Dogs (GSDs) were trained to assist blind war veterans, with the first guide dog training school being established in Oldenburg. Whilst not the first example of animals being trained to serve disabled people, it is perhaps the most notable origin of the assistance dog (Fishman, 2003). Following the success of this scheme, training schools were established in Wurttemberg, and in Potsdam and Munich where the dogs were trained to serve blind civilians. Approximately 4,000 German people had guide dogs by 1927 (Fishman, 2003). The first guide dog training school in the UK was established in 1931 and is known today as Guide Dogs UK. Current statistics show that in the UK there are over 4,950 guide dog owners (Guide Dogs UK, 2019).
What Types of Assistance Dog Are There and What Do They Do to Help Their Owners?
Guide dogs are trained to lead their blind or visually impaired owner and help them navigate obstacles that may obstruct or harm them (Guide Dogs UK, 2019). These dogs allow increased owner mobility and assist their owner in locating places, people and objects. Guide dogs are trained to have a special awareness around them, as part of their role is to help direct their owner around obstacles at height and in busy, possibly dangerous, environmental situations, such as crossing roads (Sachs-Ericsson et al., 2002). Guide dogs are trained to walk in straight lines with their owner unless instructed to lead them another way. It is believed that these animals have a higher mental demand placed on them compared to other assistance dogs as they may have to make decisions to keep their owner away from harm that disregard or are without human instruction (Sachs-Ericsson et al., 2002).
Hearing dogs inform their deaf or hearing-impaired owner about certain noises by bumping them with their nose or placing their paw on their owner’s foot, then guiding their owner to the source of the noise (Sachs-Ericsson et al., 2002). These dogs may be trained to identify up to seven different noises to help their owner. Examples of noises include a door bell ringing or their owners’ name being called. (Hearing Dogs for Deaf People, 2019)
'Service dog' is a general term for dogs assisting people with disabilities other than visual and hearing impairments (Sachs-Ericsson et al., 2002). This term encompasses mobility, psychiatric and autism assistance dogs.
Mobility assistance dogs are trained to assist people who are physically disabled by carrying out tasks that may be difficult or not possible for the owner to do by themselves (Parenti et al., 2013). Examples of such tasks include opening doors and retrieving objects (Sachs-Ericsson et al., 2002).
Psychiatric service dogs are trained specifically to alleviate the mental disabilities of their owners. These mental disabilities may include anxiety, post-traumatic stress disorder, depression and schizophrenia. Tasks these animals carry out include calling emergency services, reminding their owner about medications and helping to level their owner during panic attacks or in episodes of self-dissociation (Psychiatric Service Dogs UK, 2019).
An autism assistance dog is trained to assist a child with autism spectrum disorder (ASD), mainly by improving their safety whilst in public as the child wears a harness that is attached to the dog’s working coat, allowing the child to walk alongside the dog. The dog is handled by an adult and given instruction on how and where to walk (Sprod and Norwood, 2017).
Medical alert dogs are trained to aid people who live with chronic health conditions or disorders. Changes in smell often occur in conjunction with medical events or crises, and medical alert dogs are trained to identify these odor changes. There are a number of different health conditions that these dogs can assist with, including diabetes, Addison’s disease and postural tachycardia syndrome (Sachs-Ericsson et al., 2002).
Assistance dogs may be trained to help individual people with more than one disability. These dogs are known as dual purpose dogs. A person with multiple disabilities, such as hearing and visual impairments, will require an animal to be highly trained to meet their specific needs (Sachs-Ericsson et al., 2002).
Dog Breed Selection
Specific breeds are chosen to best fit the role they play in their owner’s life. Certain breeds are able to perform different tasks due to special traits that they show.
The most common breed used as a guide dog is the Labrador Retriever. They are very intelligent and have a reliable personality, which facilitates their training. They are appreciated for their courage, hardiness and cooperativeness (Wilsson and Sundgren, 1997). They are more affable than GSDs, react less to noise and to busy environments. Can f 1 is an allergen that stimulates human allergic response (asthma, allergic rhinitis and histamine release). It is shed in the hair of dogs but in variable amounts depending on the breed of dog. Levels of Can f 1 in the saliva of Poodles, Golden Retrievers and Labrador Retrievers were measured and it appeared that Labrador Retrievers had lower levels of Can f 1 (Breitenbuecher et al., 2016). Labrador Retrievers are less likely to have a high allergic potential. They are therefore better suited as assistance dogs because there is less of a chance for them to cause an allergic response in their owners.
The physical aspect of the dog is also very important in the selection process. Assistance dogs should meet the optimum size (53-64 cm at the withers for a guide dog) and weight (18-32 kg) (Helmink, Shanks and Leighton, 2003). They have to be the appropriate height for the owner’s reach. They also have to be of a sufficient weight to guide the owners safely, but dogs that are too heavy or large may be difficult to handle. Dogs must be able to fit into spaces that are not always made to accommodate dogs. Smaller sized dogs, such as Chihuahuas, are often used as a psychiatric and emotional support for some patients (Walther et al., 2017). The size of hearing dogs is not as important. Small breeds can easily be used but they need to be very energetic. Dogs assisting people in wheelchairs have stable personalities and are easily trainable. They provide increased mobility: pulling wheelchairs, picking up objects and operating light switches.
Heart rate is another physical trait that can be considered when selecting a breed of assistance dog. It has been proven that Golden Retrievers and Labrador Retrievers have a lower heart rate than Chihuahuas and Staffordshire Bull Terriers, amongst others (Hezzell et al., 2013). Selecting dogs with a lower heart rate limits the risk of cardiovascular disease. However, the lower heart rate of working breeds could also be a result of pressures imposed during the selection of dogs with superior cardiovascular fitness due to their active lifestyle.
Although the tests carried out enable us to have a better idea of which breed would be more suitable as an assistance dog, it can be argued that they are biased. Dogs from shelters experience high amounts of stress in their everyday life. Therefore, they will not respond in a ‘normal’ fashion to the tests performed during the selection (Weiss and Greenberg, 1997). Moreover, the performance of these dogs during the tests is not consistent with the behavior they will display later. The tests are often not sufficiently sensitive for dogs from shelters due to the differences in environment between dogs raised at home and in shelters, influencing the results of the selection tests.
Impact of Assistance Dogs on Their Owner’s Physical and Mental Well-Being
Glycaemia alert dogs are trained to respond (e.g., by vocalizing, licking, jumping, staring) to changes in their owner’s blood glucose. This is likely to be in response to changes in chemical composition of their owner’s breath or sweat, detected by olfaction (Weber et al., 2015). It is also possible that the dogs react to behavioral changes, however dogs have been reported to alert owners when in another room or asleep. A 2013 study showed that after obtaining a trained dog, all patients reported they experienced fewer hypoglycemic episodes, unconscious episodes or paramedic call outs. The performances of the dogs were also evaluated and an alert from the most successful dog was 10,000 times more likely to be out of the owner’s specified range compared to routine samples. There is no doubt that these dogs have had a positive impact on their owner’s health and safety, but they also decrease health care costs due to fewer call outs and catching episodes earlier (Rooney et al, 2013). However, most of the research in this field has been done by questionnaires. Therefore, improvements in physical health are ‘self-perceived’ and studies require owners to recall events from before and whilst owning their dog, which is not completely reliable as it is dependent on memory. Nevertheless, there is a consistent trend amongst most clients regarding improved health related quality of life.
Seizure alert dogs also have beneficial impacts on their owners in terms of their physical health and safety. These dogs are trained to alert their owners (e.g., by whining, pacing, barking, licking, staring) in response to sensing an oncoming seizure and stay with them throughout. Being alerted allows enough time for the person to take blocking medication or find a safe area and assume a safe position for when the seizure begins (Dalziel et al., 2003). To put your health in the paws of a dog is daunting and while a paper reviewing the research into seizure alert dogs showed that some seizures were missed, it was also shown that dogs are highly accurate. There were no false alarms, hence a 100% specificity (Catala et al., 2018). Having these alert dogs has a great impact in terms of safety and reduces the risk of further damage to their owner’s health, whilst also having positive impacts on their daily lives. They make their owners more comfortable going into public as they know the dog will alert them to seizures.
Medical alert dogs can also assist in clinical situations. A case report about a young girl with history of mast cell mediator release shows how assistance dogs can be beneficial to doctors in a hospital setting. Triggers for the condition include sudden temperature changes, fatigue and stress. The young girl was administered into hospital for a procedure that required anesthesia which would be stressful. As a result, arrangements were made for her alert dog to be present before and during her procedure so that the dog could alert doctors of episodes. This minimized risks to make sure that the procedure went smoothly and there was no further deterioration in the patient's health (Tew and Taicher, 2016).
Mobility assistance dogs have positive effects not just on their owner’s psychological well-being but also on their physical health. One study showed that upper limb effort decreased by 62.8% when manual wheelchair users used a mobility assistance dog to aid them up a ramp (Martin-Lemoyne et al., 2016). This reduced muscular effort was shown to be beneficial in the long term as another study showed that after seven months of using a mobility assistance dog there was a significant reduction in shoulder pain. Use of these dogs may also decrease the likelihood of their owners developing early degenerative problems of joints, maintaining the structural integrity of the shoulder (Hubert et al., 2013). So, these dogs not only aid their owners socially by giving them independence, but also physically as they reduce chances of additional decline in their owner’s health.
Drawing a concrete line between physical and mental health is not straightforward. Although there are assistance dogs with the sole purpose of helping their owners with physical disabilities, there is often an overlap where mental health is also improved.
In studies examining the effects of ownership of assistance dogs, the human-animal bond takes prevalence as a key factor: this bond is perceived to have benefits in physical and psychological aspects. Several studies have indicated such, with a reduction in levels of anxiety by provision of physical contact and companionship, reducing loneliness. This is hypothesized to be down to two reasons – the partnership of an assistance dog encouraging social interactions with different individuals and the innate relationship between dog and handler (Sachs-Ericsson, Hansen and Fitzgerald, 2002).
Tapping the potential benefits of assistance dogs has presented a major route of interest in animal-assisted therapy in the direction of assisting those with psychological conflictions, depression being a specific target (Cherniack and Cherniack, 2014).
Crowley-Robinson et al. conducted a study on the effects of a resident dog, visiting dog and control in nursing homes to reduce emotions synonymous with distress and depression. With both the use of a resident dog or visiting dog there were markedly notable reductions in levels of high depression. Moreover, this trend continued after the removal of the dog. The beneficial psychological effects were additionally seen across tension, anger, fatigue and confusion, with all decreasing, and an increase in vigor, resulting from seeing both the resident and visiting dog (Crowley-Robinson, Fenwick and Blackshaw, 1996).
The backing of psychological benefits is furthered by research undertaken by Orlandi et al. This study looked into the use of dogs in weekly therapy sessions in comparison to those receiving therapy without the presence of a dog, acting as a control. Those exposed to therapy sessions involving the dog expressed symptoms of depression and anxiety at half the severity of the control group (Orlandi et al., 2007).
Such studies highlighting the psychological benefits of assistance dogs are not restricted geographically. Studies conducted in the US, Japan and the UK discovered individuals with physical disabilities paired with assistance dogs, amongst several benefits, reported increased well-being, self-esteem and self-control. Collins et al. established individuals with progressive conditions, but those who were paired with assistance dogs had a greater disposition to experience positive emotions and social interactions, with these dogs moderating the effects of depression (Winkle, Crowe and Hendrix, 2011).
Animal’s assistance in the mental welfare of owners is only further diversifying, with a particular foothold being established in use of dogs with children with ASD. The study by Burgoyne et al. emphasized the benefits presented by use of assistance dogs, improving quality of life not only for the child with ASD but also parents. These studies highlighted social, medical, physical and, importantly, cognitive benefits (Burgoyne et al., 2019).
An experimental study conducted by Viau et al. monitored basal salivary cortisol secretion of children with ASD alongside the effects on such by assistance dogs. It was found that after pairing of an assistance dog with the child, there was a reduced ‘cortisol-awakening response’ matched by a reduced number of troublesome behavioral occurrences (Viau et al., 2010).
Studies have highlighted that the psychological benefits implicated with the partnership with an assistance dog are correlated with the ability of owners to form an attachment to the dog. This is further tied to the decision to be paired with the animal. The greater the degree of attachment, the more extensive the psychological benefits (Brown, Shaw and Kirkland, 1972).
It is further considered that partnership with an assistance dog facilitates psychological benefits through increased social interactions – the presence of the assistance dog reduces fear, increasing a feeling of safety. One study highlighted this remarkable effect with 71.1% of participants documenting a higher life satisfaction level after pairing with an assistance dog, increasing from 26.1% before partnership with their dog (Sachs-Ericsson, Hansen and Fitzgerald, 2002).
Social interaction with people is known to enhance psychological well-being, but this is also seen in canine companionship. Rintala et al.’s study found that loneliness amongst those with mobility or hearing issues paired with assistance dogs fell with improved socialization, alongside a greater assimilation with community (Rintala et al., 2008). Such studies highlight the consequential aid provided in partnership with an assistance dog, surpassing their obvious role in assistance and presenting a psychological perk.
This emphasizes the sophisticated working and living connection between an assistance dog and its owner, and the effects the dog has in providing engagement with society (Audrestch et al., 2015).
Conclusion
There is wide diversity among the assistance dog population. The selection process and the training of these dogs is very important with selection criteria depending on the use of the dog. This enables these dogs to fulfil different roles in aiding their owners, granting both physical and psychological benefits that attribute to an improvement in quality of life. Although these benefits are highlighted in several studies, the welfare of these dogs in service should be examined to ensure their well-being is not compromised in this mission. Furthermore, studies into the mental and physical health improvements facilitated by assistance dogs could be undertaken in a more objective manner, in contrast to subjective methods currently used.
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