Assessing the gait, physical activity and quality of life benefits of mobility assistance dogs for children with physical and neurological impairments

Abstract

Children with physical and neurological impairments such as cerebral palsy often have difficulty walking. Reduced activity levels and participation restrictions in these children may lead to reduced quality of life, compared to their typically developing peers. A charity in Ireland trains and provides mobility assistance dogs to children aged 6-12 with impaired walking, to help with their balance, gait and mobility. Approximately ten to fifteen mobility assistance dogs are provided per year. There is literature on the social and psychological benefits of assistance dogs, but the specific benefits of mobility assistance dogs for children and in particular any biomechanical benefits to gait, posture and balance are unknown. This study has been designed to provide qualitative and quantitative assessment of the benefits of the mobility assistance dogs provided. This study monitored physical activity, gait and quality of life of ten children with physical and neurological impairments aged 6-12 years, during and up to a six-month period. Children's activity levels, gait and quality of life were measured prior to dog placement as a baseline. Following dog placement, activity levels and quality of life were measured after one month, three months and six months. Physical activity was measured using the Stepwatch activity monitor over seven consecutive days. Quality of life was measured using the Cerebral Palsy Quality of Life (CPQoL) outcome measurement tool. Semi-structured qualitative interviews were completed at each of these time points. Children had gait analysis at the Central Remedial Clinic gait laboratory prior to placement of the dog and at six months post dog placement. In the qualitative interviews, parents perceive substantial benefits for their children in areas including social facilitation, motivation to be active and positive effects on family life. Parents perceive improvement in gait, balance and endurance in children with milder impairment. On assessment of quality of life, the group of ten children showed positive change in the domains: social-wellbeing and acceptance, feelings about functioning and emotional-wellbeing after six months. Children with more impairment showed no change in any domain measured. The group of ten children showed no change to their gait quality, measured by GDI or gait parameters speed, cadence or time in double support from baseline to six month follow up. The group showed a positive change in abdominal and left quadriceps strength, but those with more impairment (Gross Motor Function Classification Scale level III-IV) showed no change in strength measures at follow up. Children who completed a gait analysis while walking with their dog, showed little overall change at follow up. Individual clinically significant change was seen for some children. The group of ten children showed no significant change in physical activity outcomes from pre-dog to six month follow up. Children with milder impairment (GMFCS I-II) spent more time at a higher intensity of physical activity (p<0.05) at six month follow up. Children with more impairment (GMFCS III-IV) did not show change in any domain of physical activity measured. Results were highly individual and participant case studies do reflect clinically important positive change for some children, however the weather may have affected physical activity levels. Dog assisted gait training for children with physical or neurological impairments aged 6-12 leads to measurable benefits in quality of life after six months but does not lead to measurable change in gait or physical activity.