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What if there was a stroke therapy that helped to relieve stress, improve mood, encouraged some stroke patients to engage in rehabilitation and had a knock-on positive impact on healthcare staff and family members? There is, her name is Ruby, and she is an Irish therapy dog.
Ruby is a nine-year-old golden retriever and everyone’s favourite colleague on the stroke rehabilitation ward in St. James’s Hospital in Dublin. Ruby visits the unit every Tuesday with her owner Irene and spends an hour with patients and staff.
Located in the Mercers Institute for Successful Ageing (MISA), the stroke rehabilitation unit at St. James’s provides multidisciplinary rehabilitation to patients in the aftermath of a stroke.
MISA is Ireland’s first dedicated centre for successful ageing and the largest of its kind in Europe. A world class facility MISA is a seven-storey purpose built in-patient and outpatient facility with a four-storey research hub.
Professor Davis Coakley, Director of Creative Life at MISA and Honorary Fellow, Medical Gerontology in Trinity College Dublin (TCD), first proposed the centre back in 2000 and it is built on four pillars of Creative Life, Clinical, Education and Training and Research.
Roisin Nevin, Creative Life Co-ordinator at MISA is credited with bringing Ruby to St. James’s. Ruby first started to visit the stroke unit 12 months ago and the initiative has been a huge success.
“We are delighted with Ruby, Ruby has been fantastic and so has Irene. They are just a magical component that can really change the atmosphere of a ward and make a positive and universal connection that brings such benefits to both our patients and our staff,” Roisin said.
Roisin has seen for herself the beneficial impact Ruby’s visit can have on patients and she recalled one particular lady who was unsettled and out of sorts.
Her daughter was very concerned about her but “when Ruby entered her room her eyes just lit up,” Roisin said.
“She was totally engaged with Ruby, she asked about the dog, she spoke about when she was younger of previous pets they had and they could engage in that way. She was smiling, she was stroking Ruby and it was just a really enriching moment that brought happiness both to her daughter and the patient herself. It was lovely to witness this shared moment between her daughter, herself and Ruby and other staff saw it as well.”
“Ruby has had such a positive impact on this ward for our stroke patients. It is wonderful to see them smile, it is wonderful for them to open up in whatever way they so wish and to have those shared experiences with their family and with Ruby,” Roisin added.
Roisin said she would encourage other hospitals to introduce therapy dogs like Ruby so they can “understand the benefits and create an awareness of how therapy dogs can bring such positivity into an acute hospital setting that can benefit everyone.”
“Ruby has had such a positive impact on this ward for our stroke patients. It is wonderful to see them smile,"
Dr Ruth McDonagh is a Registrar and Lecturer in Stroke and Geriatric Medicine at St. James’s Hospital who has been working in the stroke service at the hospital on and off for the past six years.
Dr McDonagh said that rehabilitaion post stroke was vital for patients as it allowed them to relearn skills that may have been impaired by their stroke or helped them adapt to a new disability.
“People think of rehabilitation as physiotherapy but it can take a lot of different forms, obviously physiotherapy is one but there is also cognitive therapy, psychological, speech and functional therapy. Usually when patients in St. James’s come in they start their rehabilitation quite soon after their stroke, that can continue either as an inpatient in somewhere like MISA, or as an outpatient in their own environment which we are seeing more commonly these days,” Dr McDonagh explained.
Physiotherapy is provided seven days a week in St. James’s, which allows all new patients to start their rehabilitation within 24 hours of their stroke. Early rehabilitation is critical in giving patients the best chance of recovery after stroke.
According to Dr McDonagh, Ireland falls significantly short of providing appropriate rehabilitation services for stroke patients.
“Stroke is among the leading causes of death in Ireland and unfortunately the resource put into it doesn’t really reflect that. There are about 8,000 strokes a year in Ireland and up to 75 per cent of those people will need rehabilitation. We have less than half of the specialist rehabilitation beds required to meet international standards in that regard.”
“Stroke is among the leading causes of death in Ireland and unfortunately the resource put into it doesn’t really reflect that,"
Early Supported Discharge
Dr McDonagh pointed to Early Supported Discharge (ESD) as one area of stroke rehabilitation that despite proven to be beneficial, was particularly under resourced. With ESD, suitable stroke patients could be discharged home to continue their rehabilitation rather than having to stay in an acute hospital. Therapists then visit patients in the comfort of their own homes to complete their rehabilitation.
“It is really well established internationally as a concept and it reduces length of stay but also it produces similar, if not better outcomes in terms of rehabilitation. It also reduces the risk of requiring institutional care on a long term basis,” Dr McDonagh stated.
In Ireland there are just four ESD Teams which, according to Dr McDonagh, is enough to service about five per cent of the stroke population, whereas ideally, she said, we should have have enough to service up a third or a half of the stroke population who would benefit from ESD.
Dr McDonagh added that there was a shortage of therapists of all disciplines in stroke rehabilitation across the board.
One area where the shortages are quite striking is psychology. Approximately 70 per cent of stroke patients will experience mental health difficulties such as depression and anxiety after their stroke, which greatly impacts on their ability to engage with rehabilitation. However, Dr McDonagh said there are as little as four dedicated stroke psychologists in the country.
Commenting on Ruby and Irene’s weekly visits Dr McDonagh said, “They change the environment of the ward completely.”
“It makes the hospital feel far less like an institution and for patients who like dogs the response is quite incredible. It gives them a chance to open up and talk about something non-medical which is so rare when they are inpatients in the hospital…Sometimes it even improves their mobility because people want to be out of bed to get closer to Ruby or want to follow her around the ward. We have seen some instances where people would walk much more eagerly than they would otherwise. Sometimes it opens them up to chatting about their dog at home or a pet that they miss or have lost in the past, which can be therapeutic in its own right. We do see that patients form a bond with Ruby over several weeks in rehabilitation and you can see that interaction growing every week,” Dr McDonagh said.
She also said that from a staff perspective Ruby lifts everybody’s mood.
“Everybody is happy to see Ruby themselves and also it is quite gratifying to see how happy some patients are to see her. Even as a dog lover myself I am surprised by the testimony of patients and what they say about how Ruby has helped their therapy, it really is a very positive interaction.”
“For me personally it is very rewarding, you see the impact on people and you see improvements in people week to week or their excitement when they see the dog,"
The Ruby effect
Ruby’s presence on the ward is infectious and Annemarie Fitzmaurice, whose husband Bill Hegan had a stroke in February that affected both his speech and mobility, described her visits as “a beacon of light,” in what can otherwise be a difficult week.
Ruby’s owner Irene said that Ruby was very patient and calm.
“Dogs sense the mood of every room or every patient they come into and she knows if someone needs to give her a pet, something to change the dynamic. That is something innate in dogs and why pet therapy is valuable and important.”
Irene said that she has witnessed first hand the impact Ruby’s visits can have on patients and their families.
“I think we have visited people who have been depressed …nurses and the staff will tell you that this person hasn’t spoken in a few days or has been clearly withdrawn, and to see patients like that just light up and become completely interactive, verbal and everything else with the dog is just such a transformation. Staff will tell you that that effect will last for multiple days after we leave. The Ruby effect isn’t just for the hour that we are here, it brightens the week for people.”
Irene said that Ruby really enjoys her visits to the MISA unit and every Tuesday when Irene gets her high-vis jacket out, Ruby knows where they are going and wags her tail in anticipation.
“For me personally it is very rewarding, you see the impact on people and you see improvements in people week to week or their excitement when they see the dog. You just know you are brightening their day or giving them a lift before they go to physiotherapy or speech therapy and helping them along the way. So just doing something as simple as bringing her in for one hour a week and seeing that positive impact on people, gives me the reward I need,” Irene said.
Finally, Roisin Nevin said the success of Ruby’s visits was thanks to a number of people who worked together to secure an Irish therapy dog for the stroke unit at MISA including; Rosin Kelly, Stroke Nurse Specialist, Joe Donlon, Assistant Director of Nursing MedEl, Carol Murphy, Business Operations Manager MISA; Dr Ruth McDonagh, Registrar and Lecturer in Stroke and Geriatric Medicine, Professor Joe Harbison, Consultant in Stroke Medicine, Professor Davis Coakley Director of Creative Life, MISA and Professor Rose Anne Kenny, Director of MISA. She also mentioned the CEO of Irish Therapy Dogs, Brenda Rickard and all those working in the infection control, risk and legal departments in the hospital, who came together to ensure a dog therapy programme could be delivered in a safe way to patients.
The Irish Heart Foundation is helping to develop Stroke Support Groups all over Ireland.
Stroke Support Groups are local groups that provide a place for people affected by stroke to come together on a regular basis and to share their experiences. Stroke support groups are a fantastic way to meet others and to gather information.
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