Alternative Therapies for Children and Youth With Special Health Care Needs
Article Outline
Mary Margaret Gottesman, PhD, RN, CPNP
Ohio State University College of Nursing
Columbus, Ohio
Children and youth with special health care needs (CYSHCN) are often involved in numerous traditional therapies such as physical, speech, occupational, and respiratory therapy. Most health care professionals regularly incorporate these proven, recognized therapies into the patient’s plan of care with helpful results. Yet, there are less-familiar therapies available to CYSHCN that are often overlooked by health care professionals and unknown to parents.
Complementary and alternative medicine for children with painful chronic illnesses such as cancer or rheumatoid arthritis is becoming more mainstream, and, according to Tsao and Zeltzer (2005), interventions such as hypnosis, guided imagery, and relaxation are empirically supported as treatments for recurrent pediatric pain caused by headaches. Some interventions such as meditation, exercise, vitamins, herbs, and prayer may not even be recognized as therapy by parents (Loman, 2003). Loman (2003) suggests that health care professionals ask patients about complementary and alternative medicine practices by asking more than 1 question for clarification. Aside from the well-known interventions, there are many other options for parents and health care providers to consider on the basis of the unique needs of the child.
Pets
Animals have been used with success in therapies such as animal-assisted psychotherapy, in which animals such as dogs, cats, and birds are used to help those with psychological problems. Hyson (1983) has identified that any visit to a health care provider is stressful to a child, whether it be a routine visit or an illness-related visit. In a later study, Nagengast (1997) documented that the mere presence of a dog during a health care examination decreases a child’s stress level. Ascione (1992) reported enhanced empathy for human beings among children exposed to a school-based humane education program. Positive interaction with animals, even if it is just one’s physical presence with them or an empathetic feeling toward them, seems to benefit children.
A survey of families recently acquiring a pet found that 70% reported an increase in domestic happiness after the arrival of their pet, 60% indicated an increase in outward signs of affection around the pet, and 52% reported an increase in time that the family spent together (Cain, 1985). Animals/pets clearly impact human beings in many positive ways.
Some colleges such as Mercy College in Brewster, New York, offer pet therapy certification programs for interested providers of health care. Many hospitals and rehabilitation facilities across the country have policies in place for therapeutic visitation and animal-assisted therapy. In 1996, the Kessler Institute for Rehabilitation, New Jersey’s largest rehabilitation hospital, introduced their pet therapy program in cooperation with Ramapo Valley Animal Shelter at their Saddlebrook location. A unique part of this program is the availability of animal adoption if the patient and family are interested.
According to McDowell 2005, McDowell 2005, any therapy animal must have a predictable temperament and be obedient and non-aggressive. In addition, she suggests the use of the Delta Society’s behavioral screening tool for screening therapy animals, evidence of good health, up-to-date immunizations, and a bath or shampoo for the animal before a visit. Parents should be encouraged to explore their options for their hospitalized child and determine whether their particular hospital has a pet therapy or visitation program.
Hippotherapy
Hippotherapy uses the unique movement of a horse to achieve a child’s health care goals. Gonzalez and Hudson (2003) report that a child receives a therapeutic benefit simply by sitting on the horse. As the child works to maintain balance, the child receives numerous additional therapeutic benefits—physical, developmental and social—yet because the activity is fun, it hardly seems like work at all! The sense of freedom, trust, and pleasure the child experiences while riding seem impossible to duplicate with other treatment modalities. The success of overcoming any fear or anxiety associated with riding is also rewarding. In addition, the social benefits of a group activity are an additional plus.
McGibbon, Andrade, Widener and Cintas (1998) studied the use of hippotherapy in children with cerebral palsy. The study suggests that the use of hippotherapy may improve energy expenditure during walking and gross motor function in these children (McGibbon et al., 1998). Another study by McGibbon and Grant (2003) notes improved muscle symmetry in children with cerebral palsy following therapy on horseback. Other benefits of hippotherapy include the reduction of spasticity in the lower extremities among patients with spinal cord injuries (Lechner, Feldhaus, Gudmundsen, Hegemann, Michel, Zach, & Knecht, 2003). Mental health professionals may work with equine professionals using hippotherapy to treat individuals with mental illness or other emotional issues.
The American Hippotherapy Certification Board is a certifying organization of the American Hippotherapy Association, Inc. Although certification is voluntary, it provides formal recognition of expertise in this field of practice. Current license or certification in physical therapy, occupational therapy, or speech and language pathology is required, along with 3 years experience and 100 hours of hippotherapy practice to be eligible to take the examination to become a hippotherapy clinical specialist.
Under the guidance of a therapist, hippotherapy sessions may last 30 minutes to 1 hour. The therapist directs the horse and evaluates the child’s responses. Treatment is adjusted accordingly. Hippotherapy is not for every child, but health care providers should be prepared for questions from interested parents and families.
Music
Music therapy uses music as a tool to induce positive behavioral changes. It is particularly useful with autistic children in the area of speech remediation. It may be listed on a child’s Individualized Education Plan for special learners who are in mainstream classrooms because of its positive effects. McDowell 2005, McDowell 2005 suggests involving the child in music selection along with the parent or nurse to foster a sense of control and participation, but the selection should be from among choices that will augment the therapeutic plan.
There is much in the scientific literature to illustrate the positive effects of music. McCarthy, McElfresh, Rice and Wilson (1978) demonstrated that the use of contingent background music reduced the amount of fighting and out-of-seat behavior among emotionally disturbed children riding a school bus. The effect of melodic-rhythmic mnemonics as an aid to short-term memory was studied among normal and learning-disabled male students between 9 and 11.9 years of age. Repeated musical rehearsal in conjunction with modeling and cueing significantly improved memory retention in both groups (P < .0001) (Gfeller, 1983). In another study, background music was found to have a significant effect on work-oriented behavior among 12 developmentally handicapped persons charged with the task of sorting grocery coupons (Groeneweg, Stan, Celser, MacBeth, & Vrbancic, 1988). A significant decrease in depressive symptoms was found in adolescents who participated in a 10-week therapy program using music techniques in a group setting (Hendricks, Robinson, Bradley, & Davis, 1999).
The type of music chosen seems to affect behavior as illustrated by Harris, Bradley and Titus (1992). The researchers observed that clients in a state mental hospital acted out with more inappropriate behavior when “hard rock” and “rap” music were played in their courtyard when compared with behavior during the playing of “easy listening” or “country western” music (Harris et al., 1992).
Music has been studied in the newborn intensive care unit (Caine, 1991). Results indicate that music may have reduced initial weight loss, increased calorie intake and reduced hospital stays among the children in the study (Caine, 1991).
Music therapists obtain their certification through the Certification Board for Music Therapists located in Dowingtown, PA. The agency also provides information about music therapists and their scope of practice.
Massage therapy
The goal of most massage therapy is relaxation. Licensed massage therapists, physical therapists, and parents have used it to reduce pain and promote relaxation for years.
Massage therapy has been shown to benefit children with a wide variety of disorders. Field, Hernandez-Reif, LaGreca, Shaw, Schanberg, & Kuhn (1997) report that massage lowers glucose levels in children with diabetes. Teenagers with attention deficit hyperactivity disorder receiving massage therapy experienced short term improvement in mood state and long term improvement in classroom behavior (Field, Quintino, Hernandez-Reif, & Koslovske, 2003). In another study, adolescents receiving massage therapy, compared with those receiving relaxation therapy, were found to feel less hostile and to be perceived as less aggressive by their parents. There was no change in students receiving relaxation therapy (Diego et al., 2002).
Preterm infants who received infant massage gained more weight than infants in a control group (Field, 1998). It appears that the benefits of massage are enjoyed by those doing the massage as well. Field (1998) indicated that parents who were taught to massage their infants had less anxiety and stress.
Other types of massage include craniosacral massage to correct and restore the flow of cerebral spinal fluid through the head and spine and lymphatic massage to improve the flow of lymph.
The National Certification Board for Therapeutic Massage and Bodywork was created in 1992 and is based in Oakbrook Terrace, IL.
Color/light therapy
Light therapy has for many years been used to treat newborn jaundice and seasonal affective disorder. Also, it is well known that lack of sunlight causes poor absorption of vitamin D, which adversely affects a child’s state of calcium balance.
Color therapy uses human sensitivity to color to identify imbalances in energy patterns. Color is believed to have specific physical, emotional, and spiritual effects on human beings (Amber, 1991). Each color is thought to have a therapeutic use: blue is sedating, red is stimulating, orange is encouraging, and green is calming and balancing (Bein, 2003).
Published peer-reviewed research in the area of color and light therapy with CYSHCN is lacking.
Conclusion
While some of the therapies discussed are well researched, more peer-reviewed research studies are necessary for better understanding of the effectiveness of all of these therapies. Parents should be made aware of these therapies and encouraged to discuss these options with their health care providers. Not every therapy is appropriate for every child. Careful consideration and discussion with the child’s health care professional is essential. It is the health care professional that should determine the appropriateness of any plan of action. Boxes 1 and 2 provide additional information for caregivers and professionals for help in selecting among therapies and obtaining further information.
Ask Your Health Care Provider About:
Color and Light:
For sedation, stimulation, calming (Bein, 2003)
Hippotherapy:
May induce improved gross motor function and muscle symmetry (Lechner et al 2003, McGibbon et al 1998, McGibbon and Grant 2003)
Massage:
Provides relaxation, reduces spasticity, benefits children with ADHD (Field et al., 2003)
Music Therapy:
Induces positive behavioral change, gains in speech and language (McCarthy et al., 1978)
Pet Therapy:
Decreases stress level, positive behavioral change (Nagengast, 1997)
| Type of Therapy | Where to Find More Information | Phone |
|---|---|---|
| Animal-Assisted Psychotherapy |
Flying High Farm Christine Randle LICSW Luneburg, MA 01462 | (978) 582-7103 |
| Animal-Assisted Therapy |
Delta Society 289 Perimeter Road E Renton, WA 98055-1329 | (800)869-6898 |
| Hippotherapy |
American Hippotherapy Association 5001 Woodside Road Woodside, CA 94062 | (888)851-4592 |
| Music Therapy |
American Music Therapy Association 8455 Colesville Road Suite 1000 Silver Springs, MD 20910 | (301)589-3300 |
| Massage Therapy |
U.S. Chapter of the International Association of Infant Massage 1891 Goodyear Ave Suite 622 Ventura, AZ 93003 | (805)644-8524 |
| Color/Light Therapy |
Society for Light Treatment and Biological Rhythms 174 Cook Street San Francisco, CA 94159-1687 | (415)751-2758 |
References
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- . Aggressive adolescents benefit from massage therapy . Adolescence . 2002;37:597–607
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- . Massage therapy lowers blood glucose levels in children with diabetes mellitus . Diabetes Spectrum . 1997;10:237–239
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- . Music mnemonics as an aid to retention with normal and learning disabled students . Journal of Music Therapy . 1983;20(4):179–189
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- . The effects of background music on the vocational behavior of mentally handicapped adults . Journal of Music Therapy . 1988;3(3):118–134
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- . The effects of the presence of a companion animal on physiological arousal and behavioral distress in children during a physical examination . Journal of Pediatric Nursing . 1997;12(6):323–330
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Denise Gasalberti is Assistant Professor, Seton Hall University, College of Nursing, South Orange, NJ
PII: S0891-5245(05)00537-7
doi:10.1016/j.pedhc.2005.12.015
© 2006 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
