**4. Fields of Animal Assisted Therapies (AAT)**

himself, or could not domesticate or has not get under protection have remained as "Undomesticated-Wild". The reasons why we mention these philosophical approaches is the context of animal assisted therapies especially ethically, are applications, which are performed with animal companionship, and we would very much emphasize to use "living with the company of animals" term rather than "pet ownership" or "keeping an animal". Thus, "living with the company of animals" will be developed. May be this approach will help to develop the awareness of "living with somebody/living creature that is ill" rather than "having an ill relative". Then, experiencing the pure form of animal-human interac‐ tion at the beginning, and providing patient and his/her relatives to share this humane environment may reveal many positive effects, which we have not known or defined yet.

*Learning theory*, which is a model in psychology, defends that human beings give various responses to his/her surroundings by the learning principle. In AAT, the learning principle of the patient is triggered in a more human way; so a patient with Alzheimer´s disease can show some behaviors that he or she has started to forget, without the degree of forgetting, in the same way again, or can show some behaviors for longer times without forgetting. For example, while feeding fish in the aquarium, their eating desire may be increased or they remember eating behavior and eat some food; while feeding a dog, they may start to use hand skills, so that these will help them to improve slightly their daily life activities etc. *This interaction with animals may be perceived as a more human approach than verbal reminding of healthcare personnel and/or patient's relatives or verbal commands of caregivers what to do. While healthcare personnel and/ or patient caregivers can be under intensive stress and may unintentionally pronounce these commands at higher and sharp voice tones, and they may even say/behave in agitated ways for patients.* Therefore, animal assisted therapies and activities can be a good supportive way in long term therapy and care for individuals with chronic diseases like Alzheimer´s disease. *Cognitive theory*, which is another model in psychology, tries to explain human behaviors by investigating how human beings gain, process, and store the knowledge. Main headings in cognitive approach, which investigates perception of knowledge, processing of knowledge, and switching into behaviors, are perception language, attention, memory, problem solving, decision making-judging and

As animals do not have any expectations and demands from humans at their first contacts, patients feel self-confidence, and they may feel that everything is under their controls. [48] Therefore, animals do not react like us when they meet a healthy or ill person. We, humans, tend to perceive, remember, shape up, judge with the previously learned concepts, and even show verbal-physical behaviors, when we first meet a healthy or ill person or any living being. This situation is quickly sensed and perceived by the opposite side. When a dog meets a blind, limb or amnestic person in the street, it will behave as if it has met a healthy individual. However, when we meet people with health problems in the street, we define them as "he has got no arm!", "he is blind!", "Is he a lunatic?", "ill person", and we imply our thoughts sometimes with words or sometimes with our behaviors. Due to these reasons, animal assisted therapies naturally eradicate negative conditions like these, and they provide a more humane surrounding for therapies of subjects with chronic diseases; they support them; they increase adaptation potentials of patients and their relatives to difficult therapy periods, and they

intelligence.

308 Understanding Alzheimer's Disease

According to medical studies and field screenings, it is evident that AAT has relaxing and supportive effects on humans. Recoveries obtained in some diseases through these positive interactions are listed in Table 1. [49], [34]- [39], [50] , [51]


**Table 1.** Main improvements observed in AAT applied subjects

This supportive therapy with various services is being provided to more than 35000 patients in more than 100 healthcare service units in San Francisco. Subjects mainly benefited from these services are as follows: *Children treated in pediatric clinic; AIDS patients; patients, who require acute care and physical rehabilitation services; children with conduct disorder and physical problems; subjects staying at hospitals (patients, their relatives and hospital personnel), patients with mental diseases.* Public health organizations currently provide various services with dogs suitable for therapies. Samples for some application fields of AAT are given in Table 2 regarding human health improvement and development. [4], [52]

As Ballarini has mentioned, AAT is no longer a mysterious application, but currently it has become a treatment option, which is applied for supportive aims, and has resulted in positive outcomes in many diseases. In recent years, AAT has gained more attention all over the world, and it is being preferred as a complimentary and supportive method to improve life quality and health in some therapies, during which various problems have arisen. [45], [53], [54] Therefore, many studies have been performed to establish its scientific background, and different AAT models are being developed. Dolphin assisted therapy is one of these, and it is employed as an adjunctive method in various diseases (Table 3). [55], [56] During therapies, it has been observed that dolphins have tried to communicate with ill subjects by increasing their sound levels. [57]

#### **For psychological training**

In children with poor or underdeveloped socialization attitudes,

In conduct disorders,

In children with low academic success and low self-esteem

#### **To decrease hostile behaviors**

In jails In mental institutions with convicts In reformatory schools

#### **Psychiatric conditions**

Mild or moderate autism

In treatment and prevention of depression symptoms in old people

Anxiety

Neuro-psychological tension

#### **Medical interventions**

In recovery periods of diseases

Arterial hypertension

Cardiopathies

Chronic muscle-nervous system diseases

Different motor disorder therapies and rehabilitation

#### **Table 2.** Application fields of AAT


**5. AAT use in some chronic diseases**

ment in life quality. [46], [60]

prevention from the feeling of loneliness.

**6. Psychological and psychiatric diseases**

benefits.

Since Alzheimer´s disease is generally observed in elderly people, it may be concomitant with some other chronic diseases. Among these diseases, cardiovascular diseases are the leading ones. Conducted studies have indicated that systolic blood pressure and plasma triglyceride levels are lower in pet owner subjects when compared with the non-owners. [38] In Odendaal's study, neurochemicals (β-endorphin, oxytocin, prolactin, phenylacetic acid, dopamine, cortisol) related to drop down of blood pressure were evaluated between 18 subjects and 18 dogs before and after the positive interactions. Statistically significant data (*p*<0.05) have indicated that neurochemicals related to blood pressure are increased in both groups and attention behavior function is increased after AAT except cortisol (cortisol was low signifi‐ cantly in humans, but this decrease was not found to be significantly in dogs. [58] It has been reported in studies of another chronic disease, namely cancer, that AAT had positive effects both on patients and their relatives. [46], [59], [60] The positive effects are reported as decreased stress and anxiety; compliance with treatment and improvement in adaptation; relaxation; better nutrition; physical activity; socialization; participitating in new activities; verbalization of fright and concerns; decreased nervousness; increased feeling of happiness; thus improve‐

Animal Assisted Therapy and Activities in Alzheimer´s Disease

http://dx.doi.org/10.5772/54504

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Similar results have been obtained in studies performed on disabled subjects. [61]- [64] Especially achieved improvements were increased non-verbal interactions, physical activities, and daily life activities leading to increased life quality. Although these studies have been performed commonly in children with widespread developmental disorders, it should also be considered that Alzheimer patients may have various disabilities, which would lower their life quality, so their daily life activities may be limited according to the stage and severity of disease. When evaluated in this aspect, animal assisted therapies will provide significant

In a study performed on AIDS patients, it has been reported that cat assisted therapy has supported patients' communications with their families and friends, and has provided

Animal assisted therapies are especially employed in hospitalized children and Alzheimer patients to decrease stress. Animal companionship is employed in anxiety, refusal of therapy, refusal of eating and decreasing other agitated behaviors, treatments of various psychological and psychiatric disorders o provide treatment compliance and to increase the life quality. Patients, who are hospitalized in rehabilitation centers are scheduled for weekly or monthly therapy programs with trained animals, so physical, emotional, social and cognitive benefit of AAT are used. It has been reported that blood pressure and cardiac rate are decreased, cortisol

(stress hormone) is markedly decreased, and pain sensation is decreased.

**Table 3.** Some medical and mental health problems for application of dolphin therapy
