**4. Animal-assisted therapy in occupational therapy**

#### **4.1. The role of animal-assisted approaches in rehabilitation**

AAT is used as a therapeutic approach in rehabilitation. AAT approaches are being used all over the world in order to improve not only the emotional and psychosocial states but also the physical, sensory, and cognitive skills positively for individuals with various diseases or of different ages [37, 38]. Rehabilitation practices include holistic approaches, with divergence toward children, adolescents, adults, and elderly people.

It is known that there are many neurological, physiological, and genetic diseases seen in children, and the rehabilitation practices are widely used in these children [39]. In literature, AAT is commonly used in children with cerebral palsy, developmental neurological disorders, autism spectrum disorders, sensory processing disorders, degenerative neurological and muscle disorders that mainly focus on control of muscle tonus, mobility, and balance [40]. When the elderly and adult population rehabilitation applications are examined, it is seen that animal-assisted approaches are preferred in the treatment of diseases such as multiple sclerosis, head trauma, post-traumatic neurological conditions, Alzheimer Disease, dementia, anxiety, and depression [41–43]. These diseases can cause a reduction in postural symmetry and control, and deterioration in cognitive skills like attention, memory, and executive functions [37].

All of these patients with diseases, whether young or old, were psychologically affected, and their motivation decreased during rehabilitation. It is known that sensory, emotional, and physical characteristics of animals can be utilized to increase the level of motivation in rehabilitation. In fact, in most developed countries today, health-care providers employ animal-assisted therapy in a wide range of settings, including rehabilitation centers, acute care, psychiatric centers, and outpatient clinics. For example, doctors' consulting rooms have fish tanks in their waiting rooms to promote a sense of calm [44]. It is now well known that the presence of animals can induce relaxation, increase positive emotions, reduce resistance to treatment, and put patients' minds at ease.

Awareness of the advantages and disadvantages of the animals and species used by the professional practitioner team in rehabilitation practices involving many health disciplines involved in this area positively affect the effectiveness of rehabilitation [6]. At the same time, it also emphasizes the importance of knowing the animal's unique structure and instincts in these studies [6, 37]. Most studies and programs in AAT utilize animals such as livestocks, dolphins, dogs, cats, birds, hamsters, or horses [45]. All animals have certain advantages and disadvantages within themselves, so that the practitioner can make arrangements according to the individual and individual's needs.

## *4.1.1. Therapy with livestock*

improvements in physiological parameters, such as heart rate and blood pressure. On the other hand, pets serving as a source of social support seem to provide a relatively high level of evidence for the longer-term benefits of animal companionship [31].Cobb has defined social support as "relationships that direct, to emphasize and give importance to, to describe that it is the pattern of mutual obligations." However, the newer authors have expressed it as "perceived social support" and "social networking" characteristics. The first represents a qualitative definition of the degree of satisfaction from the support that one receives from certain social relations; the second is a more quantitative measure involving the number, frequency, and propensity of the person's general social interactions [32]. However, the importance of social support to human well-being, which we wanted to describe, has been regarded as one of the top-down issues throughout history. Loneliness—lack of social support—has always been seen as a painful and distasteful phenomenon; since ancient times, societies have used single-cell imprisonment, exile, and social mobilization as methods of punishment. This, in fact, shows that loneliness is actually the basic punishment method. In addition, religious themes explain in detail the psychological effects of autobiographical, social isolation that homeland traitors and prisoners of war wrote. Many of them describe physical torture in a way that will emotionally, often sharply, up to the apex of gradual descent. This decrease in pain is associated with the onset of a serious indifference and hopelessness, which usually requires catatonic deprivation [29]. In the last 10–15 years, a comprehensive medical literature has emerged confirming that there is a strong and positive link between social support and improved human health and survival [33–35]. There is a great deal of social support in reducing the adverse effects of stress, which chronic life has brought. With the controversy still underestimating these effects, many authorities now accept the judgment that the main benefits arise from the buffering or healing capacities of long-term effects of supporting social relations [36]. Theoretically, this beneficial effect of social support should be applied to any positive social association. It has been observed that positive behaviors are exhibited within the two parties in relation to which one is loved or respected. Despite the increasing evidence for anthro-zoological research in the recent past, the idea that animal attendants contribute

96 Occupational Therapy - Therapeutic and Creative Use of Activity

socially to human health, however, received very limited medical attention [8].

AAT is used as a therapeutic approach in rehabilitation. AAT approaches are being used all over the world in order to improve not only the emotional and psychosocial states but also the physical, sensory, and cognitive skills positively for individuals with various diseases or of different ages [37, 38]. Rehabilitation practices include holistic approaches, with divergence

It is known that there are many neurological, physiological, and genetic diseases seen in children, and the rehabilitation practices are widely used in these children [39]. In literature, AAT is commonly used in children with cerebral palsy, developmental neurological disorders,

**4. Animal-assisted therapy in occupational therapy**

**4.1. The role of animal-assisted approaches in rehabilitation**

toward children, adolescents, adults, and elderly people.

It is mentioned in the literature that all farm animals can be easily included in treatment approaches as long as they are checked by the veterinarian for good health and reliability. The benefits and difficulties of incorporating livestock into therapy approaches may vary according to the therapist's rehabilitation goal. These animals are preferred by the occupational therapists (OTs) in rehabilitation applications, in particular for those individuals who have difficulty in independent daily living skills, in terms of a large living space, and special need for care. There are also studies showing that AAT with livestock affects individuals' motor and cognitive functions positively [46, 47]. They are preferred by OTs because they can help improve their equilibrium, hand-eye coordination, executive function, and hand skills of individual.
