- Email: [email protected]
Recognizing the value of assistance dogs in society
Accepted Manuscript Recognising the value of assistance dogs in society Hilary M. Audrestch, MSc, Chantelle T. Whelan, BSc (Hons) MSc, David Grice, Lucy Asher, BSc MSc PhD, Gary C.W. England, BVetMed PhD DVetMed FRCVS, Sarah L. Freeman, BVetMed PhD PII:
S1936-6574(15)00098-9
DOI:
10.1016/j.dhjo.2015.07.001
Reference:
DHJO 411
To appear in:
Disability and Health Journal
Received Date: 28 April 2015 Revised Date:
3 July 2015
Accepted Date: 8 July 2015
Please cite this article as: Audrestch HM, Whelan CT, Grice D, Asher L, England GCW, Freeman SL, Recognising the value of assistance dogs in society, Disability and Health Journal (2015), doi: 10.1016/ j.dhjo.2015.07.001. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Recognising the value of assistance dogs in society. Hilary M. Audrestch MSca*, Chantelle T. Whelan BSc (Hons) MSca, David Griceb, Lucy Asher BSc MSc PhDa, Gary C.W. England BVetMed PhD DVetMed FRCVS a, Sarah L.
a
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Freeman BVetMed PhDa. School of Veterinary Medicine and Science, University of Nottingham, College Road,
Sutton Bonington, Loughborough, Leicestershire. LE14 2TB
School of Veterinary Guide Dogs, Unit 6, James Whatman Court, Turkey Mill, Ashford
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b
Road, Maidstone, Kent. ME14 5SS.
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*Hilary Audretsch’s current address is Flat 3, 27 Devereux Road, London, SW11 6JR Corresponding author: Sarah Freeman, [email protected], 01159 516422
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Keywords: assistance dogs; social; impact
The manuscript has not been published elsewhere, or been previously presented as an abstract
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or poster at any meetings.
(Word count, including figure legends 2957) Number of references: 26 Number of Images: 4
Disclosures: Conflicts of interest:
ACCEPTED MANUSCRIPT We wish to draw the attention of the Editor to the following facts which may be considered as potential conflicts of interest and to significant financial contributions to this work. Chantelle Whelan’s PhD studentship is funded by BBSRC and Guide Dogs; Sarah Freeman, Lucy Asher and Gary England are supervisors of Chantelle Whelan’s PhD. Lucy
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Asher and Gary England are in receipt of competitive research grant funding from Guide Dogs for two projects; (1) the Epidemiology of Guide Dog Behaviour and (2) Premature Retirement of Guide Dogs. Gary England is a veterinary surgeon who provides clinical
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service work to Guide Dogs.
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Article type: Commentary
ACCEPTED MANUSCRIPT
Abstract Assistance dogs are specially trained to undertake a variety of tasks to help individuals with
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disabilities. This review gives an overview of the different types of assistance dogs in the UK, including guide dogs, hearing dogs, mobility assistance dogs, service dogs and dualpurpose dogs. The literature describes many benefits of assistance dogs, including their
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impact on physical wellbeing and safety of their ‘owners’, as well as on psychological wellbeing and social inclusion. The role of assistance dogs in society is widely recognised by
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the public, but is not currently acknowledged in government social policy. The current evidence on the benefits of assistance dogs is limited by the type and scale of current research. This article highlights the need for independent funding for high quality research to enable social care and policy makers to make evidence-based decisions on the value of
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(146 words)
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assistance dogs to people with disabilities.
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Keywords: assistance dogs; social; impact
1. Assistance dogs within the UK Assistance dogs are trained to allow people to achieve an optimal level of functional independence. Dogs have aided people with disabilities for thousands of years, with documented cases dating back to Roman times1. The three most common types of assistance dogs in the UK are guide dogs, hearing dogs and mobility assistance dogs.
ACCEPTED MANUSCRIPT Guide Dogs Guide dogs are trained to lead visually impaired individuals around various obstacles, offering increased mobility, location of objects and destinations. They have arguably higher
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demands than the other types of assistance dogs2. Guide dogs must learn to avoid environmental features which may come into contact with their owner, including objects at height. Training principles such as straight line work are introduced to aid user orientation, where the dog must walk only in straight lines unless requested otherwise. Stopping at each
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curb they encounter is introduced for safety and owner orientation. The number of tasks that a
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guide dog must learn is great, however it is the degree to which decisions must be made in the absence of, or contrary to, human cues which sets them apart from other assistance dogs. Although the owner provides cues as to when it is safe to cross a road, the dog must show selective disobedience and ignore these cues if it is not safe to cross. Fast and accurate
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decisions in such contexts are vital for a guide dog3. [Image 1]
The use of guide dogs has been part of European culture for hundreds of years, with some of the earliest descriptions dating back to the 13th Century1. The first recorded school to train
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guide dogs was established in Germany after the first world war, and the first training school in the UK, Guide Dogs UK, was founded shortly afterwards in 19311. There are currently
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4,922 guide dog owners in the UK, with over 800 new partnerships trained every year; 564 people are currently on the waiting list for a Guide Dog3. This is only a small percentage of the 1,996,885 peoplepeople in the UK with visual impairment, 18% of which are registered as blind or partially sighted due to severe or irreversible sight loss4. Hearing Dogs Hearing Dogs for Deaf People, launched in 1982, train dogs to alert their hearing impaired or deaf owners to a number of specific sounds by touching their owner’s foot with a paw, or
ACCEPTED MANUSCRIPT nudging them with their nose. The dogs are trained to recognise up to seven different sounds, including fire alarms, kitchen timers, doorbells and telephones. When alerted to the sound, the owner asks “what is it?” using a signal or their voice, and their dog will lead them to the source of the noise, or lie down in the case of a fire alarm alert. Hearing Dogs for Deaf
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People have trained over 1,600 dogs and currently have over 750 working partnerships in the UK5.
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Mobility Assistance Dogs
Dogs for the Disabled, founded in 1988, were the first charity in the UK to train mobility
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assistance dogs for physically disabled adults. They have trained over 661 dogs, and currently have 278 working partnerships across England and Wales6. Canine Partners for Independence, founded in 1990, also train dogs to provide assistance with daily tasks that can be difficult, painful or impossible for people with mobility impairments to perform7. Mobility
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assistance dogs offer greater independence to people with mobility impairments through practical support; performing such tasks as opening doors, turning on lights and retrieving
Service Dogs
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objects8. [Image 2]
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Mobility assistance dogs are defined as ‘Service dogs’ by Assistance Dogs International (2013)9. Other assistance dogs that come under this category include medical detection dogs, autism assistance dogs and psychological assistance dogs. Medical detection dogs are kept as companion animals by people with medical conditions with symptoms that can be detected by the dog prior to their onset; these include detecting odour changes associated with specific events such as low blood sugar concentrations in a diabetic person or an oncoming seizure in someone with epilepsy10. Autism Spectrum Disorder (ASD) is a developmental disorder, often characterised by limited social skills, with individuals failing to read social cues and
ACCEPTED MANUSCRIPT struggling to communicate with others11. Autism assistance dogs are paired with children on the autistic spectrum and help mediate social interactions between ASD children and others and facilitate social interactions for these children12. Whilst not currently utilised in the UK, other countries have introduced psychological assistance dogs. These dogs work with people
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with a range of mental illnesses including depression and various anxiety disorders. Some of the duties carried out by these dogs include reminding their owners to take medication, helping to wake those whose medication makes it difficult to wake up, and providing support
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when feeling anxious.
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Dual-purpose dogs
Organisations within Assistance Dogs UK also collaborate to train dogs in multiple assistance roles for individuals with more than one disability. This began in 2003 when Hearing Dogs and Guide Dogs trained a dog in both roles for an individual with visual and hearing
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impairments. There are still a relatively small number of dual-purpose dogs, as they are highly skilled to meet to specific individual needs. [Image 4]
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2. Benefits of assistance dogs.
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main benefits of assistance dogs are to help reduce the negative impact of an individual’s condition over a variety of areas including simplifying daily activities, increasing safety, encouraging positive social exchange and improving psychological well-being13. A systematic review of the evidence for the effectiveness of assistance dogs for people with disabilities identified benefits of assistance dogs, but described many issues with the quality of evidence14. Most of the current evidence is based on qualitative studies investigating a single aspect of the relationship between an owner and an assistance dog, and is often underpowered or subject to bias. Questionnaires or interviews with successful assistance dog
ACCEPTED MANUSCRIPT partnerships may only capture an individual perspective from a limited number of people, and an assistance dog partnership is often a complex multidimensional relationship.. Daily Life, Health and Safety Benefits The most commonly reported benefit, and the main purpose of an assistance dog partnership,
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is the improved ability to carry out daily tasks2,8,14,15. Research conducted by Guide Dogs UK in 1999 showed that approximately 20% of visually impaired adults never leave their home without human assistance. The use of a guide dog renders the need for human assistance
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unnecessary in many cases, allowing enhanced freedom; participation in society was a key benefit identified in a survey of guide dog owners and non-dog owners2. Retrospective
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studies showed that hearing, physical assistance and guide dogs enhanced functioning for their owners at home and in the community, and self-care and chores within the home were made simpler15-17. The benefits of working with an assistance dog were best summarised as an overall increase in owner independence8.
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The research findings on benefits vary with different studies, and most studies are subject to some limitations or bias. Telephone interviews of 831 visually impaired people, 404 of which
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were guide dog owners described that their quality of life had improved following the assistance dog partnership, compared to those who received their first cane to aid with their
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impairment, who reported no such improvement2. The researcher was based within Guide Dogs, and therefore there was potential for research bias. Similar benefits have been reported with other assistance dogs. A study of 57 people who had received an assistance dog from Dogs for the Disabled investigated the impact on their overall well-being, including selfperceived physical health15. Whilst the numbers of participants were relatively small, this represented 90% of the total recipients of an assistance dog from this organisation at the time of the study. The study reported that 47% of the participants believed that their physical health was better since acquiring the dog (using a Likert scale from disagree to agree), but no
ACCEPTED MANUSCRIPT data was given on how the responses of the remaining 43% of participants were distributed15. This study also reported that 51% of participants thought that the dog allowed them to worry less about their health, and 69% felt that they were ‘more relaxed’ since having the dog15, but again no data was presented on the participants who disagreed with this statement. This study
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was also associated with the relevant charitable organisation, and therefore also has potential for research bias.
In a study of 38 owners of hearing assistance dogs, the majority felt that their dogs fulfilled
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their chief expectations18. Being alerted to sounds was the most frequently mentioned reason
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for acquiring a hearing assistance dog (51.6% of owners), followed by protection (20.5%) and companionship (15.3%)18. The theme of protection as a benefit is much less common in research on assistance dogs for visual impairment2. The study of hearing dogs also reported lower stress levels in owners compared to a control group of 15 individuals on a waiting
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list18. Psychological and Social Benefits
Although the primary reason for obtaining an assistance dog usually relates to support in
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carrying out daily tasks, the majority of assistance dog owners also describe improvements in social interactions as a result of their partnership2,8,15,19,20. In a study conducted for Dogs for
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the Disabled, 92% of assistance dog recipients reported an increase in social integration, and 73% noted that they had made new friends since the beginning of the partnership15. A further two studies reported that adults and children using wheelchairs recognised an enhanced number of positive social acknowledgements when accompanied by their assistance dog21,22. Users of hearing dogs reported similar observations; 76.5% experienced an increase in interactions with the hearing community after receiving their dogs18. Guide dog owners not only reported similar quantitative improvements in social interactions with the public, but they also identified qualitative changes in these interactions, describing communication from
ACCEPTED MANUSCRIPT the public as more respectful and less condescending following their pairing with a dog2. The guide dog appears to act as a social facilitator for sighted individuals possessing little experience interacting with the visually impaired, providing a focal point away from the perceived disability2. It is important to note that for a small percentage of people, they
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consider that the dog brings unwanted attention from other people2. Overall however, the studies indicate that the value of assistance dogs extends beyond daily working tasks, to include enhanced opportunities for positive social exchange.
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It is difficult to separate the potential psychological effects of assistance dog ownership from
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pre-existing psychological differences that may motivate individuals to acquire a dog or not19. However, two retrospective studies strongly indicate positive psychological effects of assistance dog partnerships, with increased independence, better self-esteem, increased confidence and assertiveness, decreased feelings of loneliness and depression reported by over 70% of participants in each study16,23. Self-esteem was measured by Rintala et al. (2002)
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using the Rosenberg self-esteem scale, which is a validated quantitative measure of impact17. Participants rated statements such as “I take a positive attitude toward myself” on a scale of
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1-7, from ‘very untrue for me’ to ‘very true for me’. The results of the survey suggested that self-esteem improved after pairing with assistance dogs compared to before. Hart et al.
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(1996) found that hearing impaired individuals partnered with a hearing dog suffered less stress from stressful life events than those on the waiting list for a hearing dog. Furthermore, those in a hearing dog partnership reported significantly less loneliness than the waiting list group18. The control group in this study however consisted of people on a waiting list for an assistance dog, and the desire to have a dog and the uncertainty of waiting means that this may not represent the most appropriate reference group for comparison. Companionship was identified the third most important reason for acquiring a hearing dog, after alerting to sounds and protection18. Although this study had a low number of
ACCEPTED MANUSCRIPT participants (38), the importance of companionship is echoed in findings from other studies: a survey of 40 mobility assistance dog owners showed companionship to be the second most frequently mentioned reason for desiring an assistance dog, after aiding with mobility impairments in daily life17. Companionship was cited as a significant benefit to guide dog
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ownership in Whitmarsh’s study of 403 guide dog owners, along with increased mobility, confidence and socialising2. The reduction in feelings of loneliness reported by owners of each type of assistance dog suggests that assistance dogs do indeed act as important
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companions18. 93% of respondents to the survey by Lane et al. (1998) claimed that their dog was a valued member of the family15. Companionship itself is known to benefit our
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psychological well-being. Studies on the positive impacts of canine companionship on humans show consistencies with the benefits associated with human company19. Consistently reported findings of decreases in loneliness and improved social integration imply a significance of assistance dogs that far exceeds their initial assistance role, and
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highlights the complex relationships that exists between a dog, its owner and society 2, 17, 21. Negative aspects or potential barriers to owning a guide dog have also been explored2. In
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non-guide dog owners, these included misconceptions about eligibility criteria (44% of nonowners), concerns about the cost and practicalities of training with, owning and caring for an
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assistance dog, and ‘no perceived need’ for an assistance dog (23% of non-owners). 51% of the 402 guide dog owners identified drawbacks of owning a guide dog, including the inconvenience of owning a dog, unwanted attention from people, and emotional distress when the dog is retired, ill or dies. Inconvenience was the most commonly identified drawback (33% of men and 25% of women). This included practical issues such as dog hairs and cleaning up after the dog, but the main drawback was places where ‘it was not possible or convenient to take the dog’ (28% of men and 33% of women who identified drawbacks). These are similar to findings on the negative impacts of owning a hearing assistance dog,
ACCEPTED MANUSCRIPT which included behavioural or working problems, the owner having to undertake additional tasks around training with assistance dogs and travel arrangements when they have a dog, and gaining access to some facilities18. It is important to note that some of the key issues identified reflect lack of information (misunderstanding of eligibility criteria), and the issues
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raised around travel and public access often reflect societal issues and accessibility rather
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than failings of the partnership.
Impact on society
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The research described above highlights the potential benefits of assistance dogs and the impact on an individual’s wellbeing and social inclusion. The role of assistance dogs is however not always recognised in social policy. The main documents which relate to policy on disabilities and society include the UN Convention on the Rights for Persons with
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Disabilities (2009), and the UK Care Act (2014) 23,24. The UN Convention on the Rights for Persons with Disabilities (2009) is a 37 page document which includes the general objectives for the convention. It describes an objective as ‘research and development of…. new
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technologies, including information and communications technologies.’, but gives no
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mention of the role or value of assistance dogs throughout the entire document23. The UK Care Act 2014 has six aspects of their definition of wellbeing, including ‘physical and mental health and emotional wellbeing’, ‘control by the individual over day-to-day life (including over care and support provided and the way it is provided)’, and ‘participation in work, education, training or recreation’24. This reflects many of the ways that assistance dogs can contribute to wellbeing. However, assistance dogs are not mentioned in the 167 page document of the UK Care Act 2014, despite the emphasis of the Act on wellbeing, social inclusion and disabilities24. There are a number of possible reasons for this. In the UK,
ACCEPTED MANUSCRIPT assistance dogs are funded entirely through the third (charity) sector, and although this is unlikely to change, this should not preclude their contributions to society being recognised. Despite widespread recognition of the role of assistance dogs, there is a need for further evidence on their contribution to ‘One Health’ (an initiative to link Human and Veterinary
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Medicine to improve health of both humans and animals), wellbeing and society25. The
systematic review of evidence in 2012, assessed 12 studies on the use of assistance dogs
(termed ‘service’ dogs in this study) for people with mobility related physical disabilities, and
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described the evidence as ‘promising’ but ‘inconclusive and limited’ due to the issues with the quality and levels of evidence14. Much of the research is also generated or supported by
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assistance dog charities and therefore is not independent. Finally, most studies are qualitative, and therefore can be difficult for policy makers to interpret findings and quantify benefits . The impact of an assistance dog is complex, with many interlinking factors, such as the role of the dog, the dog’s behaviour and skills, the individual’s needs and involvement with
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society, the support framework within family and the community, and the interaction of an assistance dog partnership with society. Capturing all these aspects is challenging, and will require multi-disciplinary approaches, and novel methodologies which consider the different
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components of a partnership.
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There can be no doubt that assistance dogs have a major impact and change the lives of individual people, and in many circumstances, they can provide benefits and independence above that offered through existing social care. Currently assistance dogs are only used by a small percentage of people with disabilities, and although assistance dog organisations have been established within the UK for over 80 years, we still lack robust evidence which quantifies their benefits. The omission of assistance dogs from social care policy or from strategic funding fails to recognise their role as part of an integrated approach to enhancing wellbeing and social inclusion of people with disabilities. Independent research
ACCEPTED MANUSCRIPT funding, multi-disciplinary approaches and higher levels of evidence are required to enable social care and policy makers to make evidence-based decisions, and to document and recognise the true value of assistance dogs within society.
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(Word count 2971) Image legends.
Image 1. Guide Dog partnership. Guide dogs must stop at each curb they encounter. They
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must also learn to disobey their owner if they are asked to cross the road and it is not safe to
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do so.
Image 2. Dogs for the Disabled assistance dog partnership. Dogs for the Disabled provide assistance with a range of daily tasks, including retrieving and carrying objects. Image 3. Canine partners assistance dog. Canine partners provide assistance with a range of
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daily tasks, in this case selecting and retrieving items during shopping. Image 4. Dual purpose assistance dogs are highly skilled dogs that are specifically trained to
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assist individuals with multiple disabilities.
References
1. Fishman, G. A. 2003. When your eyes have a wet nose: The evolution of the use of guide dogs and establishing the seeing eye. Survey of Ophthalmology, 48, 452-458.
2. Whitmarsh, L. 2005. The benefits of guide dog ownership. Visual Impairment Research. 7(1), 27-42 doi:10.1080/13882350590956439 3. Guide Dogs UK (2015) Guide Dogs Services http://www.guidedogs.org.uk/services#.VQaoiY7keKg [Accessed 16/03/2015].
ACCEPTED MANUSCRIPT 4. RNIB 2009. Future sight loss UK (1): The economic impact of partial sight and blindness in the UK adult population. Report prepared for RNIB by Access Economics Pty Limited June 2009. https://www.rnib.org.uk/sites/default/files/FSUK_Summary_1.pdf, [Accessed
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1.12.14]
5. Hearing Dogs for Deaf People 2015. About our working dogs.
http://www.hearingdogs.org.uk/what-we-do/our-dogs [Accessed 16/03/15]
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6. Dogs for the Disabled. 2014. What We Do: Dogs for the Disabled UK. Available from: http://www.dogsforthedisabled.org/what-we-do [Accessed 26/03/2014].
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7. Canine Partners. 2014. How a canine partner helps: Canine Partners for Independence UK. Available from: http://www.caninepartners.org.uk/how-a-canine-partner-helps [Accessed 26/03/2014].
8. Rintala, D. H., Matamoros, R., Seitz, L. L. 2008. Effects of assistance dogs on
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persons with mobility or hearing impairments: A pilot study. Journal of Rehabilitation Research and Development, 45, 489-503. 9. Assistance Dogs International. 2015. Service Dogs.
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http://www.assistancedogsinternational.org/about-us/types-of-assistance-dogs/service-
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dog/ [Accessed 27/3/2015]
10. Wells, D.L., Lawson, S.W., Siriwardena, A.N. 2008 Canine Responses to Hypoglycaemia in Patients with Type 1 Diabetes Journal of Alternative and Complementary Medicine, 14 (10 ), 1235-1241. . 11. APA (American Psychiatric Association). (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). doi:10.1176/appi.books.9780890423349
ACCEPTED MANUSCRIPT 12. Solomon, O. 2010. What a dog can do. Children with autism and therapy dogs in social interaction. Ethos, 38(1), 143-166. 13. Sachs-Ericsson, N., Hansen, N. K., Fitzgerald, S. 2002. Benefits of assistance dogs: A review. Rehabilitation Psychology, 47, 251-277.
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14. Winkle, M., Crowe, T. K., Hendrix, I. 2012. Service dogs and people with physical disabilities partnerships: A systematic review. Occupational Therapy International,
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19, 54-66.
15. Lane, D. R., Mcnicholas, J., Collis, G. M. 1998. Dogs for the disabled: Benefits to
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recipients and welfare of the dog. Applied Animal Behaviour Science, 59, 49-60. 16. Fairman, S.K., Huebner, R.A. 2001 Service dogs: A compensatory resource to improve function. Occupational Therapy in Health Care,13, 41-52. 17. Rintala, D. H., Sachs-Ericsson, N., Hart, K.A. 2002. The effect of service dogs on
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persons with mobility impairments: A pre-post study design. SCI Psychosocial Process, 15, 70-82.
18. Hart, L. A., Zasloff, R. L., Benfatto, A. M. 1996. The socializing role of hearing dogs.
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Applied Animal Behaviour Science, 47, 7-15.
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19. Serpell, J. 1991. Beneficial effects of pet ownership on some aspects of human health and behaviour. Journal of the Royal Society of Medicine, 84, 717-720.
20. Guest, C. M., Collis, G. M., Mcnicholas, J. 2006. Hearing dogs: A longitudinal study of social and psychological effects on deaf and hard-of-hearing recipients. Journal of Deaf Studies and Deaf Education, 11, 252-261. 21. Hart, L. A., Hart, B. L., Bergin, B. 1987. Socializing effects of service dogs for people with disabilities. Anthrozoos, 1, 41-44.
ACCEPTED MANUSCRIPT 22. Eddy, J., Hart, L.A., Boltz, R.P. 1988The effects of service dogs on social acknowledgments of people in wheelchairs. Journal of Psychology, 122, 39-45. 23. Convention on the rights of persons with disabilities. 2009. Available from: http://www.un.org/disabilities/documents/convention/convoptprot-e.pdf [Accessed
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27/03/2015] 24. Care Act 2014. Available from:
[Accessed 1/12/14] 25. One Health Initiative. Mission Statement.
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http://www.legislation.gov.uk/ukpga/2014/23/pdfs/ukpga_20140023_en.pdf
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http://www.onehealthinitiative.com/index.php [Accessed 02/02/2015]
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ACCEPTED MANUSCRIPT
S1936-6574(15)00098-9
DOI:
10.1016/j.dhjo.2015.07.001
Reference:
DHJO 411
To appear in:
Disability and Health Journal
Received Date: 28 April 2015 Revised Date:
3 July 2015
Accepted Date: 8 July 2015
Please cite this article as: Audrestch HM, Whelan CT, Grice D, Asher L, England GCW, Freeman SL, Recognising the value of assistance dogs in society, Disability and Health Journal (2015), doi: 10.1016/ j.dhjo.2015.07.001. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Recognising the value of assistance dogs in society. Hilary M. Audrestch MSca*, Chantelle T. Whelan BSc (Hons) MSca, David Griceb, Lucy Asher BSc MSc PhDa, Gary C.W. England BVetMed PhD DVetMed FRCVS a, Sarah L.
a
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Freeman BVetMed PhDa. School of Veterinary Medicine and Science, University of Nottingham, College Road,
Sutton Bonington, Loughborough, Leicestershire. LE14 2TB
School of Veterinary Guide Dogs, Unit 6, James Whatman Court, Turkey Mill, Ashford
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b
Road, Maidstone, Kent. ME14 5SS.
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*Hilary Audretsch’s current address is Flat 3, 27 Devereux Road, London, SW11 6JR Corresponding author: Sarah Freeman, [email protected], 01159 516422
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Keywords: assistance dogs; social; impact
The manuscript has not been published elsewhere, or been previously presented as an abstract
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EP
or poster at any meetings.
(Word count, including figure legends 2957) Number of references: 26 Number of Images: 4
Disclosures: Conflicts of interest:
ACCEPTED MANUSCRIPT We wish to draw the attention of the Editor to the following facts which may be considered as potential conflicts of interest and to significant financial contributions to this work. Chantelle Whelan’s PhD studentship is funded by BBSRC and Guide Dogs; Sarah Freeman, Lucy Asher and Gary England are supervisors of Chantelle Whelan’s PhD. Lucy
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Asher and Gary England are in receipt of competitive research grant funding from Guide Dogs for two projects; (1) the Epidemiology of Guide Dog Behaviour and (2) Premature Retirement of Guide Dogs. Gary England is a veterinary surgeon who provides clinical
M AN U
SC
service work to Guide Dogs.
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Article type: Commentary
ACCEPTED MANUSCRIPT
Abstract Assistance dogs are specially trained to undertake a variety of tasks to help individuals with
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disabilities. This review gives an overview of the different types of assistance dogs in the UK, including guide dogs, hearing dogs, mobility assistance dogs, service dogs and dualpurpose dogs. The literature describes many benefits of assistance dogs, including their
SC
impact on physical wellbeing and safety of their ‘owners’, as well as on psychological wellbeing and social inclusion. The role of assistance dogs in society is widely recognised by
M AN U
the public, but is not currently acknowledged in government social policy. The current evidence on the benefits of assistance dogs is limited by the type and scale of current research. This article highlights the need for independent funding for high quality research to enable social care and policy makers to make evidence-based decisions on the value of
EP
(146 words)
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assistance dogs to people with disabilities.
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Keywords: assistance dogs; social; impact
1. Assistance dogs within the UK Assistance dogs are trained to allow people to achieve an optimal level of functional independence. Dogs have aided people with disabilities for thousands of years, with documented cases dating back to Roman times1. The three most common types of assistance dogs in the UK are guide dogs, hearing dogs and mobility assistance dogs.
ACCEPTED MANUSCRIPT Guide Dogs Guide dogs are trained to lead visually impaired individuals around various obstacles, offering increased mobility, location of objects and destinations. They have arguably higher
RI PT
demands than the other types of assistance dogs2. Guide dogs must learn to avoid environmental features which may come into contact with their owner, including objects at height. Training principles such as straight line work are introduced to aid user orientation, where the dog must walk only in straight lines unless requested otherwise. Stopping at each
SC
curb they encounter is introduced for safety and owner orientation. The number of tasks that a
M AN U
guide dog must learn is great, however it is the degree to which decisions must be made in the absence of, or contrary to, human cues which sets them apart from other assistance dogs. Although the owner provides cues as to when it is safe to cross a road, the dog must show selective disobedience and ignore these cues if it is not safe to cross. Fast and accurate
TE D
decisions in such contexts are vital for a guide dog3. [Image 1]
The use of guide dogs has been part of European culture for hundreds of years, with some of the earliest descriptions dating back to the 13th Century1. The first recorded school to train
EP
guide dogs was established in Germany after the first world war, and the first training school in the UK, Guide Dogs UK, was founded shortly afterwards in 19311. There are currently
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4,922 guide dog owners in the UK, with over 800 new partnerships trained every year; 564 people are currently on the waiting list for a Guide Dog3. This is only a small percentage of the 1,996,885 peoplepeople in the UK with visual impairment, 18% of which are registered as blind or partially sighted due to severe or irreversible sight loss4. Hearing Dogs Hearing Dogs for Deaf People, launched in 1982, train dogs to alert their hearing impaired or deaf owners to a number of specific sounds by touching their owner’s foot with a paw, or
ACCEPTED MANUSCRIPT nudging them with their nose. The dogs are trained to recognise up to seven different sounds, including fire alarms, kitchen timers, doorbells and telephones. When alerted to the sound, the owner asks “what is it?” using a signal or their voice, and their dog will lead them to the source of the noise, or lie down in the case of a fire alarm alert. Hearing Dogs for Deaf
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People have trained over 1,600 dogs and currently have over 750 working partnerships in the UK5.
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Mobility Assistance Dogs
Dogs for the Disabled, founded in 1988, were the first charity in the UK to train mobility
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assistance dogs for physically disabled adults. They have trained over 661 dogs, and currently have 278 working partnerships across England and Wales6. Canine Partners for Independence, founded in 1990, also train dogs to provide assistance with daily tasks that can be difficult, painful or impossible for people with mobility impairments to perform7. Mobility
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assistance dogs offer greater independence to people with mobility impairments through practical support; performing such tasks as opening doors, turning on lights and retrieving
Service Dogs
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objects8. [Image 2]
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Mobility assistance dogs are defined as ‘Service dogs’ by Assistance Dogs International (2013)9. Other assistance dogs that come under this category include medical detection dogs, autism assistance dogs and psychological assistance dogs. Medical detection dogs are kept as companion animals by people with medical conditions with symptoms that can be detected by the dog prior to their onset; these include detecting odour changes associated with specific events such as low blood sugar concentrations in a diabetic person or an oncoming seizure in someone with epilepsy10. Autism Spectrum Disorder (ASD) is a developmental disorder, often characterised by limited social skills, with individuals failing to read social cues and
ACCEPTED MANUSCRIPT struggling to communicate with others11. Autism assistance dogs are paired with children on the autistic spectrum and help mediate social interactions between ASD children and others and facilitate social interactions for these children12. Whilst not currently utilised in the UK, other countries have introduced psychological assistance dogs. These dogs work with people
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with a range of mental illnesses including depression and various anxiety disorders. Some of the duties carried out by these dogs include reminding their owners to take medication, helping to wake those whose medication makes it difficult to wake up, and providing support
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when feeling anxious.
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Dual-purpose dogs
Organisations within Assistance Dogs UK also collaborate to train dogs in multiple assistance roles for individuals with more than one disability. This began in 2003 when Hearing Dogs and Guide Dogs trained a dog in both roles for an individual with visual and hearing
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impairments. There are still a relatively small number of dual-purpose dogs, as they are highly skilled to meet to specific individual needs. [Image 4]
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2. Benefits of assistance dogs.
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main benefits of assistance dogs are to help reduce the negative impact of an individual’s condition over a variety of areas including simplifying daily activities, increasing safety, encouraging positive social exchange and improving psychological well-being13. A systematic review of the evidence for the effectiveness of assistance dogs for people with disabilities identified benefits of assistance dogs, but described many issues with the quality of evidence14. Most of the current evidence is based on qualitative studies investigating a single aspect of the relationship between an owner and an assistance dog, and is often underpowered or subject to bias. Questionnaires or interviews with successful assistance dog
ACCEPTED MANUSCRIPT partnerships may only capture an individual perspective from a limited number of people, and an assistance dog partnership is often a complex multidimensional relationship.. Daily Life, Health and Safety Benefits The most commonly reported benefit, and the main purpose of an assistance dog partnership,
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is the improved ability to carry out daily tasks2,8,14,15. Research conducted by Guide Dogs UK in 1999 showed that approximately 20% of visually impaired adults never leave their home without human assistance. The use of a guide dog renders the need for human assistance
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unnecessary in many cases, allowing enhanced freedom; participation in society was a key benefit identified in a survey of guide dog owners and non-dog owners2. Retrospective
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studies showed that hearing, physical assistance and guide dogs enhanced functioning for their owners at home and in the community, and self-care and chores within the home were made simpler15-17. The benefits of working with an assistance dog were best summarised as an overall increase in owner independence8.
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The research findings on benefits vary with different studies, and most studies are subject to some limitations or bias. Telephone interviews of 831 visually impaired people, 404 of which
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were guide dog owners described that their quality of life had improved following the assistance dog partnership, compared to those who received their first cane to aid with their
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impairment, who reported no such improvement2. The researcher was based within Guide Dogs, and therefore there was potential for research bias. Similar benefits have been reported with other assistance dogs. A study of 57 people who had received an assistance dog from Dogs for the Disabled investigated the impact on their overall well-being, including selfperceived physical health15. Whilst the numbers of participants were relatively small, this represented 90% of the total recipients of an assistance dog from this organisation at the time of the study. The study reported that 47% of the participants believed that their physical health was better since acquiring the dog (using a Likert scale from disagree to agree), but no
ACCEPTED MANUSCRIPT data was given on how the responses of the remaining 43% of participants were distributed15. This study also reported that 51% of participants thought that the dog allowed them to worry less about their health, and 69% felt that they were ‘more relaxed’ since having the dog15, but again no data was presented on the participants who disagreed with this statement. This study
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was also associated with the relevant charitable organisation, and therefore also has potential for research bias.
In a study of 38 owners of hearing assistance dogs, the majority felt that their dogs fulfilled
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their chief expectations18. Being alerted to sounds was the most frequently mentioned reason
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for acquiring a hearing assistance dog (51.6% of owners), followed by protection (20.5%) and companionship (15.3%)18. The theme of protection as a benefit is much less common in research on assistance dogs for visual impairment2. The study of hearing dogs also reported lower stress levels in owners compared to a control group of 15 individuals on a waiting
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list18. Psychological and Social Benefits
Although the primary reason for obtaining an assistance dog usually relates to support in
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carrying out daily tasks, the majority of assistance dog owners also describe improvements in social interactions as a result of their partnership2,8,15,19,20. In a study conducted for Dogs for
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the Disabled, 92% of assistance dog recipients reported an increase in social integration, and 73% noted that they had made new friends since the beginning of the partnership15. A further two studies reported that adults and children using wheelchairs recognised an enhanced number of positive social acknowledgements when accompanied by their assistance dog21,22. Users of hearing dogs reported similar observations; 76.5% experienced an increase in interactions with the hearing community after receiving their dogs18. Guide dog owners not only reported similar quantitative improvements in social interactions with the public, but they also identified qualitative changes in these interactions, describing communication from
ACCEPTED MANUSCRIPT the public as more respectful and less condescending following their pairing with a dog2. The guide dog appears to act as a social facilitator for sighted individuals possessing little experience interacting with the visually impaired, providing a focal point away from the perceived disability2. It is important to note that for a small percentage of people, they
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consider that the dog brings unwanted attention from other people2. Overall however, the studies indicate that the value of assistance dogs extends beyond daily working tasks, to include enhanced opportunities for positive social exchange.
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It is difficult to separate the potential psychological effects of assistance dog ownership from
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pre-existing psychological differences that may motivate individuals to acquire a dog or not19. However, two retrospective studies strongly indicate positive psychological effects of assistance dog partnerships, with increased independence, better self-esteem, increased confidence and assertiveness, decreased feelings of loneliness and depression reported by over 70% of participants in each study16,23. Self-esteem was measured by Rintala et al. (2002)
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using the Rosenberg self-esteem scale, which is a validated quantitative measure of impact17. Participants rated statements such as “I take a positive attitude toward myself” on a scale of
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1-7, from ‘very untrue for me’ to ‘very true for me’. The results of the survey suggested that self-esteem improved after pairing with assistance dogs compared to before. Hart et al.
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(1996) found that hearing impaired individuals partnered with a hearing dog suffered less stress from stressful life events than those on the waiting list for a hearing dog. Furthermore, those in a hearing dog partnership reported significantly less loneliness than the waiting list group18. The control group in this study however consisted of people on a waiting list for an assistance dog, and the desire to have a dog and the uncertainty of waiting means that this may not represent the most appropriate reference group for comparison. Companionship was identified the third most important reason for acquiring a hearing dog, after alerting to sounds and protection18. Although this study had a low number of
ACCEPTED MANUSCRIPT participants (38), the importance of companionship is echoed in findings from other studies: a survey of 40 mobility assistance dog owners showed companionship to be the second most frequently mentioned reason for desiring an assistance dog, after aiding with mobility impairments in daily life17. Companionship was cited as a significant benefit to guide dog
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ownership in Whitmarsh’s study of 403 guide dog owners, along with increased mobility, confidence and socialising2. The reduction in feelings of loneliness reported by owners of each type of assistance dog suggests that assistance dogs do indeed act as important
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companions18. 93% of respondents to the survey by Lane et al. (1998) claimed that their dog was a valued member of the family15. Companionship itself is known to benefit our
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psychological well-being. Studies on the positive impacts of canine companionship on humans show consistencies with the benefits associated with human company19. Consistently reported findings of decreases in loneliness and improved social integration imply a significance of assistance dogs that far exceeds their initial assistance role, and
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highlights the complex relationships that exists between a dog, its owner and society 2, 17, 21. Negative aspects or potential barriers to owning a guide dog have also been explored2. In
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non-guide dog owners, these included misconceptions about eligibility criteria (44% of nonowners), concerns about the cost and practicalities of training with, owning and caring for an
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assistance dog, and ‘no perceived need’ for an assistance dog (23% of non-owners). 51% of the 402 guide dog owners identified drawbacks of owning a guide dog, including the inconvenience of owning a dog, unwanted attention from people, and emotional distress when the dog is retired, ill or dies. Inconvenience was the most commonly identified drawback (33% of men and 25% of women). This included practical issues such as dog hairs and cleaning up after the dog, but the main drawback was places where ‘it was not possible or convenient to take the dog’ (28% of men and 33% of women who identified drawbacks). These are similar to findings on the negative impacts of owning a hearing assistance dog,
ACCEPTED MANUSCRIPT which included behavioural or working problems, the owner having to undertake additional tasks around training with assistance dogs and travel arrangements when they have a dog, and gaining access to some facilities18. It is important to note that some of the key issues identified reflect lack of information (misunderstanding of eligibility criteria), and the issues
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raised around travel and public access often reflect societal issues and accessibility rather
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than failings of the partnership.
Impact on society
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The research described above highlights the potential benefits of assistance dogs and the impact on an individual’s wellbeing and social inclusion. The role of assistance dogs is however not always recognised in social policy. The main documents which relate to policy on disabilities and society include the UN Convention on the Rights for Persons with
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Disabilities (2009), and the UK Care Act (2014) 23,24. The UN Convention on the Rights for Persons with Disabilities (2009) is a 37 page document which includes the general objectives for the convention. It describes an objective as ‘research and development of…. new
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technologies, including information and communications technologies.’, but gives no
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mention of the role or value of assistance dogs throughout the entire document23. The UK Care Act 2014 has six aspects of their definition of wellbeing, including ‘physical and mental health and emotional wellbeing’, ‘control by the individual over day-to-day life (including over care and support provided and the way it is provided)’, and ‘participation in work, education, training or recreation’24. This reflects many of the ways that assistance dogs can contribute to wellbeing. However, assistance dogs are not mentioned in the 167 page document of the UK Care Act 2014, despite the emphasis of the Act on wellbeing, social inclusion and disabilities24. There are a number of possible reasons for this. In the UK,
ACCEPTED MANUSCRIPT assistance dogs are funded entirely through the third (charity) sector, and although this is unlikely to change, this should not preclude their contributions to society being recognised. Despite widespread recognition of the role of assistance dogs, there is a need for further evidence on their contribution to ‘One Health’ (an initiative to link Human and Veterinary
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Medicine to improve health of both humans and animals), wellbeing and society25. The
systematic review of evidence in 2012, assessed 12 studies on the use of assistance dogs
(termed ‘service’ dogs in this study) for people with mobility related physical disabilities, and
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described the evidence as ‘promising’ but ‘inconclusive and limited’ due to the issues with the quality and levels of evidence14. Much of the research is also generated or supported by
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assistance dog charities and therefore is not independent. Finally, most studies are qualitative, and therefore can be difficult for policy makers to interpret findings and quantify benefits . The impact of an assistance dog is complex, with many interlinking factors, such as the role of the dog, the dog’s behaviour and skills, the individual’s needs and involvement with
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society, the support framework within family and the community, and the interaction of an assistance dog partnership with society. Capturing all these aspects is challenging, and will require multi-disciplinary approaches, and novel methodologies which consider the different
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components of a partnership.
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There can be no doubt that assistance dogs have a major impact and change the lives of individual people, and in many circumstances, they can provide benefits and independence above that offered through existing social care. Currently assistance dogs are only used by a small percentage of people with disabilities, and although assistance dog organisations have been established within the UK for over 80 years, we still lack robust evidence which quantifies their benefits. The omission of assistance dogs from social care policy or from strategic funding fails to recognise their role as part of an integrated approach to enhancing wellbeing and social inclusion of people with disabilities. Independent research
ACCEPTED MANUSCRIPT funding, multi-disciplinary approaches and higher levels of evidence are required to enable social care and policy makers to make evidence-based decisions, and to document and recognise the true value of assistance dogs within society.
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(Word count 2971) Image legends.
Image 1. Guide Dog partnership. Guide dogs must stop at each curb they encounter. They
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must also learn to disobey their owner if they are asked to cross the road and it is not safe to
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do so.
Image 2. Dogs for the Disabled assistance dog partnership. Dogs for the Disabled provide assistance with a range of daily tasks, including retrieving and carrying objects. Image 3. Canine partners assistance dog. Canine partners provide assistance with a range of
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daily tasks, in this case selecting and retrieving items during shopping. Image 4. Dual purpose assistance dogs are highly skilled dogs that are specifically trained to
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assist individuals with multiple disabilities.
References
1. Fishman, G. A. 2003. When your eyes have a wet nose: The evolution of the use of guide dogs and establishing the seeing eye. Survey of Ophthalmology, 48, 452-458.
2. Whitmarsh, L. 2005. The benefits of guide dog ownership. Visual Impairment Research. 7(1), 27-42 doi:10.1080/13882350590956439 3. Guide Dogs UK (2015) Guide Dogs Services http://www.guidedogs.org.uk/services#.VQaoiY7keKg [Accessed 16/03/2015].
ACCEPTED MANUSCRIPT 4. RNIB 2009. Future sight loss UK (1): The economic impact of partial sight and blindness in the UK adult population. Report prepared for RNIB by Access Economics Pty Limited June 2009. https://www.rnib.org.uk/sites/default/files/FSUK_Summary_1.pdf, [Accessed
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1.12.14]
5. Hearing Dogs for Deaf People 2015. About our working dogs.
http://www.hearingdogs.org.uk/what-we-do/our-dogs [Accessed 16/03/15]
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6. Dogs for the Disabled. 2014. What We Do: Dogs for the Disabled UK. Available from: http://www.dogsforthedisabled.org/what-we-do [Accessed 26/03/2014].
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7. Canine Partners. 2014. How a canine partner helps: Canine Partners for Independence UK. Available from: http://www.caninepartners.org.uk/how-a-canine-partner-helps [Accessed 26/03/2014].
8. Rintala, D. H., Matamoros, R., Seitz, L. L. 2008. Effects of assistance dogs on
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persons with mobility or hearing impairments: A pilot study. Journal of Rehabilitation Research and Development, 45, 489-503. 9. Assistance Dogs International. 2015. Service Dogs.
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http://www.assistancedogsinternational.org/about-us/types-of-assistance-dogs/service-
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dog/ [Accessed 27/3/2015]
10. Wells, D.L., Lawson, S.W., Siriwardena, A.N. 2008 Canine Responses to Hypoglycaemia in Patients with Type 1 Diabetes Journal of Alternative and Complementary Medicine, 14 (10 ), 1235-1241. . 11. APA (American Psychiatric Association). (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). doi:10.1176/appi.books.9780890423349
ACCEPTED MANUSCRIPT 12. Solomon, O. 2010. What a dog can do. Children with autism and therapy dogs in social interaction. Ethos, 38(1), 143-166. 13. Sachs-Ericsson, N., Hansen, N. K., Fitzgerald, S. 2002. Benefits of assistance dogs: A review. Rehabilitation Psychology, 47, 251-277.
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14. Winkle, M., Crowe, T. K., Hendrix, I. 2012. Service dogs and people with physical disabilities partnerships: A systematic review. Occupational Therapy International,
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19, 54-66.
15. Lane, D. R., Mcnicholas, J., Collis, G. M. 1998. Dogs for the disabled: Benefits to
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recipients and welfare of the dog. Applied Animal Behaviour Science, 59, 49-60. 16. Fairman, S.K., Huebner, R.A. 2001 Service dogs: A compensatory resource to improve function. Occupational Therapy in Health Care,13, 41-52. 17. Rintala, D. H., Sachs-Ericsson, N., Hart, K.A. 2002. The effect of service dogs on
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persons with mobility impairments: A pre-post study design. SCI Psychosocial Process, 15, 70-82.
18. Hart, L. A., Zasloff, R. L., Benfatto, A. M. 1996. The socializing role of hearing dogs.
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Applied Animal Behaviour Science, 47, 7-15.
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19. Serpell, J. 1991. Beneficial effects of pet ownership on some aspects of human health and behaviour. Journal of the Royal Society of Medicine, 84, 717-720.
20. Guest, C. M., Collis, G. M., Mcnicholas, J. 2006. Hearing dogs: A longitudinal study of social and psychological effects on deaf and hard-of-hearing recipients. Journal of Deaf Studies and Deaf Education, 11, 252-261. 21. Hart, L. A., Hart, B. L., Bergin, B. 1987. Socializing effects of service dogs for people with disabilities. Anthrozoos, 1, 41-44.
ACCEPTED MANUSCRIPT 22. Eddy, J., Hart, L.A., Boltz, R.P. 1988The effects of service dogs on social acknowledgments of people in wheelchairs. Journal of Psychology, 122, 39-45. 23. Convention on the rights of persons with disabilities. 2009. Available from: http://www.un.org/disabilities/documents/convention/convoptprot-e.pdf [Accessed
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27/03/2015] 24. Care Act 2014. Available from:
[Accessed 1/12/14] 25. One Health Initiative. Mission Statement.
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http://www.legislation.gov.uk/ukpga/2014/23/pdfs/ukpga_20140023_en.pdf
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http://www.onehealthinitiative.com/index.php [Accessed 02/02/2015]
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