Interview by Frank Long, MS, Editorial Director, Rehab Management

Not all patients love therapy. Some avoid it, some hide from it, a few may even say they would prefer a root canal. Getting patients enthused about their rehab programs can be tricky, but clinicians at Kessler Institute for Rehabilitation, headquartered in West Orange, NJ, have found a solution in one simple command: “Release the dogs!”

The inpatient and outpatient therapy departments at Kessler are supported by six “facility dogs”—golden retrievers and yellow Labrador retrievers—bred and selected for their temperament and size, to help motivate and inspire patients. The dogs can not only participate in functional activities with patients but can actually make them feel better just by showing up. If that seems hard to believe, consider that scientific research confirms that talking to a dog lowers blood pressure more than talking to a human, and gazing into a dog’s eyes spikes human oxytocin levels.1,2

Two Kessler therapists who work with facility dogs speak with Rehab Management about how the dogs facilitate a higher level of creativity and effectiveness in therapy programs while helping to manage patient behaviors and outcomes in surprising ways.

Paoli being groomed by a young man recovering from a C4  complete SCI, using a counter balance arm sling, dorsal wrist  extension splint, and an adaptive brush. Patient-reported shoulder mobility was much more enjoyable while grooming a dog.

Paoli being groomed by a young man recovering from a C4 complete SCI, using a counter balance arm sling, dorsal wrist extension splint, and an adaptive brush. Patient-reported shoulder mobility was much more enjoyable while grooming a dog.

Mary and Paoli

“He’s my secret weapon”

Mary van der Meer, DPT, has been working at Kessler for 5 and one-half years in the inpatient physical therapy department. She is a board-certified clinical specialist in neurological physical therapy and has worked with a variety of patients including those recovering from stroke, brain injury, amputation, spinal cord injury, and other neurological illnesses. Paoli is van der Meer’s 6-year-old male golden retriever, who she describes as “goofy and friendly.”

How did this program come about?

Kessler’s Canine Companions for Independence (CCI) program began back in 2006. The dogs are partnered with both PTs and OTs, and we currently have six CCI facility dogs within our three inpatient and outpatient rehab facilities. It’s the largest CCI program in the nation. CCI trains four different types of dogs. They train service dogs, which are what you think of when you think of a typical service dog that is partnered with adults who have a full disability. They also have hearing dogs, who alert their partners when key sounds are made. They train skilled companion dogs who are paired to work with an adult or child with a disability under the guidance of a facilitator, which is usually a parent. And, of course, they train facility dogs, which are partnered with a facilitator in healthcare or in an education setting. They’re used mainly to motivate and inspire patients and clients. Facility dogs are the type of dogs that Kessler has.

How did you become involved with the CCI program at Kessler?

My first day at Kessler I was a nervous new grad, I was sitting at the lunch table, and up walks this old sweet yellow lab and he just puts his head right on my lap. That was day one, and I was like, “This is pretty cool.” He just made me feel calm and connected to the group, and I could only imagine that was the same effect he had on patients. When Kessler decided to grow their CCI program more, they asked me if I would be interested and I quickly signed up.

Why is this program important for inpatient rehabilitation?

The people who are in inpatient rehab have just arrived, and they’ve had something very traumatic happen. They’re learning what life looks like after this event and how to regain their independence. Many of them miss their own food, their own bed, and many of them miss their own dogs, too. So when they see Paoli he brings a sense of normalcy to them at a very abnormal time. Just by reaching out a paw or resting his head on their knees, he communicates comfort and warmth. In addition to the actual skills Paoli can integrate into treatment, he also provides a calming effect and nonverbal communication.

What is the experience like from the therapist’s side?

I consider Paoli my secret weapon. If a patient doesn’t feel like doing anything, meet Paoli. Or, if a patient feels particularly upset or begins to get agitated, I’m going to bring in Paoli. Patients love him, and co-workers love him. It is work for the dogs, though. It is stressful for them to always be meeting new people or traveling in a car and being in a healthcare environment.

When we say the dogs are “working,” what does that mean?

It depends on what the patient needs them for. I can use him a lot in treating spinal cord injuries (SCI). Consider that with an SCI on day one you’re usually getting someone on the mat, and you’re assessing their sitting balance. And the patient is usually scared out of their mind because it’s their first time moving in the gym. In these cases I would have Paoli sit next to the person in the gym, or maybe have Paoli curled up between the person’s legs and just helping him or her get used to a new position with a furry friend who is giving a little bit of extra help and comfort.

As the patient is progressing and working on dynamic tasks, I could have the patient play tug-o-war with Paoli as a way to work on strength and balance. Certainly some people would find that more fun than a therapy band.

I also use him a lot for standing tolerance or for standing control. So I would have Paoli standing on an elevated table or elevated mat in front of the patient. I can have the patient reach in certain directions to groom or brush certain parts of Paoli to get the patient to weight shift in different directions. Fetch is an easy tool because I can place the ball in different directions—on the floor or overhead—and then have the patient grab the ball and throw it to Paoli and have Paoli retrieve it. Patients love it, and as therapy it’s far more fun when you’re doing it with a dog.

Paoli is long-haired, which creates some possibilities. One thing I’ve done is hide clothespins in his fur and then have the patient practice removing them from his fur while in an unsupported position. That activity gets patients to work the different grasps and things like that, which is fun for them.

Even walking Paoli I think is really great. I use him a lot if the patient has left-sided neglect. I’ll position Paoli on the patient’s left side and then have the patient try to locate the dog. He can bark on command—that’s one of his 40 commands—so it will startle the patient to the left. Or walking a dog while holding on with the left hand to try to attract some type of attention over to that left side.

What are some of your favorite success stories?

We just had a young woman here who is 28 years old and living with autism. She has a very flat affect and is tearful, never smiled during therapy, and had a really tough time talking. But, she loves animals, and during her stay she spent a lot of time working with Paoli. She groomed him, she played games with him, and she smiled when Paoli beat her at these games. She practiced giving Paoli commands to practice voicing, and she would grin when he would listen to her. When we started gait training, Paoli would sit in a chair with a sign in his mouth that said, “You got this.” A couple of weeks ago together with her OT, she and I even gave Paoli a bath in the patient’s shower room. That was a wet but really fun treatment session. The confidence that I saw in her when she worked with Paoli was powerful, and I don’t think she’ll ever forget him.

Paoli cheers on a patient while serving as a “finish line” for an ambulation trial.

Paoli cheers on a patient while serving as a “finish line” for an ambulation trial.

What would surprise therapists most about this program?

That facility canines are provided free of charge. The amount of training that goes into these dogs confers on them a value of approximately $50,000. But I think most therapists would be surprised at how effective these dogs are at motivating and encouraging our patients. And I was just thinking that years after being discharged from Kessler the patient comes back, they don’t often remember their therapist’s name, but you bet they remember that golden retriever or yellow lab.

Ashley and Keltie

“…it completely changes the dynamic of my treatment”

Ashley McKenna, PT, DPT, has been at Kessler Institute for Rehabilitation for two and one-half years of the 3 years she has been in practice. She is a level 2 therapist at Kessler working in the outpatient neuro setting, specializing in any neurological diagnoses and is concussion certified. Keltie is McKenna’s 3-year-old female pure golden retriever.

How did you become involved with the CCI program at Kessler?

During my second week of work I was walking and I saw one of the dogs and, as most people do, I got very excited and started asking a lot of questions. I went to my supervisor during my first work review and I said, “I would like to get a dog.” It was very early in my employment at Kessler to ask this, but I told them I would like to be the next person to do this and that I thought it would help me grow as a clinician. My supervisor put me in touch with another staff member who already had a dog, and she talked me through it and discussed what the expectations would be, then we contacted CCI and talked about how to move forward. Before I could do it, though, I had to get approval from a lot of people, including the CEO of the hospital.

How does the program benefit outpatient rehabilitation?

The dog adds a completely new component to therapy. For a lot of people they’re going through their recovery and the emotional state they’re in during the outpatient phase is a little different from what it was while they were an inpatient. Sometimes we have to give the “realist” answer to them and tell them that things are going to get better, but you might not get back exactly to where you were before. It is nice to have the emotional comfort the dog provides to the patient while we have those tough conversations.

And, it completely changes the dynamic of my treatment. I’m able to do a lot more specific training for my patients, especially patients who have dogs themselves and have a goal of wanting to walk their dogs safely again. I can show them how to properly walk with their dog after they’ve had a stroke or brain injury so that it’s safe for them and for the animal when they return home.

It also adds a new component of fun. Sometimes people don’t really want to be at therapy, but once they bring out the dog we notice the patient is much more engaged and is smiling. We do activities that make it fun for them, and if they’re having fun they don’t realize how hard they’re working.

What is the experience like from the therapist’s side?

It makes it more fun. I get to be creative at an even higher level, which I think has sharpened my skills as a therapist. When I started at Kessler I was a new graduate and fresh out of school, and I felt like I had some really good ideas. Then, you kind of get into a lull after working for awhile. Then I got Keltie, and it revamped everything. It added a whole new tool set for me and a whole new set of skills for how I can integrate the dog into all different levels of treatment, and how I can also co-treat with my counterparts in speech and occupational therapy.

What are some of the therapeutic activities for which you have used Keltie?

There are so many. Having the patients play fetch with the dog is an excellent one because the patient is not only using the arm but what we’re able to do is progress the activity so that it’s working on balance. The big one I’ve been utilizing lately is tug-o-war, where I’m having the patient either stand or kneel on an unstable surface such as a BOSU ball or foam. For this type of activity the patient has to keep their balance and keep their core tight as they’re playing tug-o-war and the dog is pulling them. That one has been utilized in so many different positions with so many different patients, as well as just “sitting balance,” which is an activity where a patient has to maintain the ability to sit while the dog is pulling them in different directions.

Keltie performs a skilled “Tug” activity to work on patient’s abilities with balance, proprioception, and righting reactions with the goal of improving patient’s balance under dynamic conditions.

Keltie performs a skilled “Tug” activity to work on the patient’s abilities with balance, proprioception, and righting reactions with the goal of improving the atient’s balance under dynamic conditions.

Another big one we’ve been doing lately with some of our younger patients is more sport-specific work. For example, my dog knows how to pass the ball back and forth. So I’ve had these young patients be able to stand and keep their balance and kick a soccer ball while Keltie passes it back with her nose. That activity is fun, functional, and great for the patients to use their legs and balance.

What are some of your favorite success stories?

The most notable was a very severe brain injury patient we had, and throughout the time he started to get bored and he had a lot of difficulty engaging and keeping his focus during sessions. He was very distractable, he would get irritated, and he would get angry. He was my patient. Once I went away and brought my dog back, it completely changed our sessions. He engaged and he was working harder, and his progress just went through the roof. For him it added a new component of happiness and joy when he was there, and he was no longer dreading therapy. His sitting balance got better, he was communicating more and his speech got better, he was reaching forward to pet the dog so his arm movement and his fine motor skills to pet her using a brush got better. So we were able to use my dog for all three areas using speech, PT, and OT.

My other one was a younger patient who was an amputee and very nervous about trying to walk her dog—especially because she had to use a cane. So what we started doing was to have her practice walking with Keltie all through the clinic, and we would have her practice walking outside and going up and down curbs. Initially I had to hold on to her, but as she grew more confident she began to start walking without me holding on, then she finally was able to walk with her dog and she brought in videos of her taking her dogs for walks around the neighborhood.

What would surprise therapists most about this program?

I think the cost of the program and how much care and training is needed for these animals. They have the puppy raisers who do socialization with the dogs, then they go to the training facility and all the hours of training that these trainers put in with these dogs, and how they specialize their training. And then we, the therapists, go for training. I think many of my colleagues would be surprised about how much attention and care and practice is needed to mold Keltie into the dog she is.

I think they would also be surprised about the effect the dogs have on treatment efficacy. I think originally everyone thought, “Oh, we’re going to have a dog in the clinic, and we can pet it.” But now that they’ve seen what the dog can actually do, it’s opened a lot of eyes about the creativity that therapists can put into their own treatment. RM


1. Vormbock JK, Grossberg JM. Cardiovascular effects of human-pet dog interactions. J Behav Med. 1988;11(5):509–517.

2. Nagasawa M, Mitsui S, En S, et al. Social evolution. Oxytocin-gaze positive loop and the coevolution of human-dog bonds. Science. 2015;348(17):333–336.