Journal of Communication Disorders 40 (2007) 215–224

Case report

The effect of a therapy dog on the communication
skills of an adult with aphasia
Caroline LaFrance a, Linda J. Garcia b,*, Julianne Labreche b,c
a
Commission Scolaire Des Bois-Francs, Victoriaville, Que., Canada
Audiology and Speech-Language Pathology Program, School of Rehabilitation Sciences,
University of Ottawa, 451 Smyth Rd., Room 3076, Ottawa, Ont. K1H 8M5, Canada
c
Department of Communication Disorders, The Rehabilitation Centre, The Ottawa Hospital,
Ottawa, Canada
b

Received 13 July 2005; received in revised form 27 April 2006; accepted 8 June 2006

Abstract
Little evidence-based research has been published within the field of communication disorders on
the role of dogs as catalysts for human communication. This single participant study, a point of entry
into this realm of research, explores the effects of a therapy dog on the communication skills of a
patient with aphasia receiving intensive speech and language therapy within a rehabilitation setting.
The researchers conclude that the presence of the dog does have the potential to stimulate both overt
social-verbal and social-nonverbal communication.
Learning outcomes: As a result of this activity the reader will be able to (1) describe the beneficial
role of dogs to serve as catalysts for human communication (2) describe ways in which a person with
aphasia may be assisted by a therapy dog and (3) become familiar with an animal-assisted therapy
(AAT) program set-up for patients with communication disorders within a rehabilitation setting.
# 2006 Elsevier Inc. All rights reserved.

1. Introduction
Although anecdotal evidence abounds, the beneficial role of dogs to serve as catalysts
for human communication has received little attention to date in the field of
communication disorders. Outside the formal scope of practice of speech-language
* Corresponding author. Tel.: +1 613 562 5254; fax: +1 613 562 5428.
E-mail address: linda.garcia@uottawa.ca (L.J. Garcia).
0021-9924/$ – see front matter # 2006 Elsevier Inc. All rights reserved.
doi:10.1016/j.jcomdis.2006.06.010

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pathology however, in other areas of research including veterinary sciences, psychiatry,
nursing, occupational therapy and psychology, more documented evidence exists.
In our society, dogs serve as companion animals and pets, therapy dogs, assistance (e.g.
guide dogs) and service animals. Since the 1980s, published literature, although limited,
has documented the positive effects of pets, including dogs. These benefits include
increased social opportunities, increased feelings of security, and companionship (Abdill &
Juppe, 1997; Lopez, 1996; Willis, 1997). To some degree, of course, these benefits depend
on personal preferences and group values within our multicultural society. Not everyone
likes dogs. Nevertheless, for those individuals who do like dogs and are not allergic to
them, the human-animal bond can be caring, compassionate and powerful.
1.1. The role of dogs as empathic listeners
Although it is not clear exactly how much receptive language ability a dog possesses,
dogs are capable of understanding some human communication. No matter whether the
training be hand signals or verbal commands or a combination of both, dogs can learn a
variety of training commands. More significantly, people who are isolated, lonely or
institutionalized often find solace with friendly dogs and view them as empathic listeners.
The literature supports the role of dogs to assist socially withdrawn and psychiatric
patients in a listening capacity. A study by Bardill and Hutchinson (1997) explored the role of
a dog with 30 volunteer participants, hospitalized adolescents in a closed psychiatric unit. In
journal entries of these teenagers, researchers found that the dog served as a sounding board
for the hospitalized youths. These young people, by experience, often learned that it was
dangerous to talk to others, especially adults. Communication involved risk of criticism,
rejection, evaluation, punishment, inattention, judgment and unsolicited advice.
By contrast, the dog (Graham), a 2-year-old cocker spaniel, listened attentively, giving
empathetic nonverbal feedback. Teenagers were heard to practice with the dog what they
intended to say to their family or doctor. One patient wrote: ‘‘Sometimes you can talk to
him when you can’t talk to anybody else. He doesn’t judge you. He can’t say, ‘‘Oh you’re
stupid.’’ Other patients commented: ‘‘When I have problems with people I just sit down
with Graham. He’s such a good listener.’’ (Bardill and Hutchinson, 1997, p. 21.)
In a similar study, questions posed to a psychiatric patient who refused to speak resulted
in an increase in words per answer when a ‘canine co-therapist’ was used (Corson &
Corson, 1980). This husband–wife team of researchers were early pioneers in the role of
dogs as compassionate listeners for troubled individuals who chose to withdraw from
human-to-human contact.
1.2. The role of dogs as social catalyst
Churchill, Safaoui, McCabe, and Baun (1999) examined how interactions with an
unfamiliar dog in a one-to-one setting improved socialization in patients with Alzheimer’s
disease and decreased their agitation. Similarly, Kongable, Stolley, and Buckwalter (1990)
found that staff from a special care Alzheimer’s unit reported the presence of a dog
provided these patients with a reminiscing focal point of pet ownership memories and a
focal point for orientation to the present. Staff also indicated that the animal served ‘‘as a

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link in the relationship between the Alzheimer’s disease client and their family’’ (Kongable
et al., 1990, p. 19). The use of dogs with persons suffering from Alzheimer’s disease
resulted in positive effects on communicative variables such as smiles, laughs, touches and
verbalizations (Kongable, Buckwalter, & Stolley, 1989). Fick (1993) reported the impact of
the presence and absence of a dog on social interactions among male nursing home
residents. She found twice the number of verbal-person and nonverbal-person interactions
occurring when the dog was present.
Based on evidence reported in a questionnaire distributed by Lane, McNicholas and
Collis (1995) to individuals with service dogs, 92% reported that when their dog
accompanied them, people stopped to talk to them more often than when they did not have
a dog. Similar studies (Eddy, Hart, & Boltz, 1998; Hart & Bergin, 1987; Mader, Hart &
Bergin 1989) compared persons using wheelchairs with and without service dogs and
measured the number of social acknowledgments. They found that in a variety of different
settings, social acknowledgments were consistently higher for people using wheelchairs if
they were accompanied by a service dog. The literature supports the view that social
facilitation and increased communication occur in the presence of a service dog.
1.3. The role of dogs to assist people with aphasia
Little published research is available on the role that family pets and working dogs may
play to improve the quality of life of men and women with aphasia, although anecdotal
evidence suggests their role may be significant. For instance, among the participants at a
spring 2004 Walk and Talk-A-Thon, sponsored by the Aphasia Centre of Ottawa-Carleton,
Canada was a middle-aged man with a severe non-fluent aphasia whose life had been
enhanced by his volunteer job of training young, potential guide dogs. The training suited
his communication style, a combination of short verbal commands and simple hand
signals. The severity of his aphasia had prevented any possible return to the work force.
A native Canadian aboriginal with aphasia, whose spirituality included a worship of
nature, was distant with his Caucasian stroke service rehabilitation therapists but actively
participated in this rehabilitation centre’s animal-assisted therapy (AAT) program with the
dog. A woman with a fluent aphasia in this same AAT program, embarrassed by her pattern
of jargon, avoided contact with strangers initially but continued to enjoy the friendly
companionship of her pet.
A single case study from a speech-language pathologist’s perspective (Adams, 1997)
examined the impact of two therapy dogs on the communication skills of a 72-year-old
woman with an apraxia of speech following two cerebral vascular accidents. It concluded
that the therapy did have a positive effect. Her anecdotal observations included a dog-walk
activity at the end of each session, noting that other residents and staff were drawn to this
activity and spoke to the patient about her canine companion.
1.4. The canine role disputed: the novelty factor
Critics argue that the positive effects of pet-facilitated programs within institutionalized
settings may simply be due to the introduction of a novel and exciting stimuli, in this case a
visiting dog, and may wane as familiarity grows.

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An investigation by Hall and Malpus (2000), a research design on which this research is
modeled, was carried out in a long-term psychiatric nursing home in England. Researchers
examined the presence of the dog handler as a possible confounding variable. Perhaps, they
questioned, it was the handler and not the dog that sparked communicative attempts by the
residents.
Their investigation incorporated an A-B-C-A reversal design. It involved 10 clients, all
men, with severe and enduring psychiatric illness who displayed institutionalized behavior
including a reluctance to initiate interaction, a lack of conversational ability and little
expressed interest in their environment. The dog (Phoenix) was part of the Pets as Therapy
(PAT) program and trained to high standards of obedience.
Initially, observations of the social-verbal and social-nonverbal behaviors of the clients
were noted without dog or dog handler present (condition A). Observations were then
undertaken with the handler present (condition B). The dog was then introduced for a
period of 14 weeks (condition C). Finally, in the last part of the study, both dog and dog
handler were removed (condition A).
The researchers concluded that the effects on social behavior among the participants
were greater with the presence of a handler and dog than with the handler alone. The
authors concluded that pet visitation did yield beneficial effects within a population with
severe mental health problems. ‘‘The findings of this study support the notion that it is
indeed the pet, not the human handler, which promotes social interaction’’ (Hall & Malpus,
2000, p. 2225).

2. Purpose
The purpose of this study was to explore the impact of the presence of the dog and
handler during walks back to the ward on the overt social-verbal and social nonverbal
communication skills of a sole participant with aphasia. Its design was modeled on the Hall
and Malpus study described above.

3. Method
3.1. The participant
The participant was a 61-year-old male assessed by a speech-language pathologist and
found to have a non-fluent aphasia secondary to a left cerebral vascular accident (CVA)
sustained in November 2002. The participant was admitted to The Rehabilitation Centre,
an affiliate of The Ottawa Hospital, in Ottawa, Canada 1-month post-onset for a full
multidisciplinary inpatient treatment program that included speech and language therapy.
Upon admission, he had difficulty carrying out simple directions (WAB, Sequential
Commands 4/80). His yes–no responses were no greater than chance (WAB, Auditory
Verbal Comprehension 33/60). He had difficulty pointing to real objects (WAB 0/6), forms
(WAB 1/6), letters (WAB 2/6), numbers (WAB 2/6), and furniture (WAB 0/6). Word
finding problems were evident (WAB 40/60). An initial Content Unit Analysis revealed

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severe deficits with 10 words/min and six correct information units. Initially, he was unable
to write or use a keyboard. Reading was nonfunctional. Visual neglect, visual perceptual
deficits and language deficits interfered with reading skills. Math skills were severely
compromised.
He was seen by the same speech-language pathologist for the duration of his
rehabilitation stay. This gentleman received hour-long speech therapy sessions five times
weekly, Monday through Friday, for the 12-week inpatient stay. Subsequently, he was
followed twice weekly as an outpatient for 7 weeks until discharge. At discharge,
functional improvement was significant and measurable. He was able to follow sequential
commands (WAB 80/80). His yes–no responses were considerably improved (WAB 57/
60). He was better able to point to real objects (WAB 6/6), drawn objects (WAB 6/6), forms
(WAB 6/6), letters (WAB 6/6), numbers (WAB 6/6) and furniture (WAB 6/6). Expressively,
word finding problems improved considerably (WAB Object Naming 60/60). A repeat
Content Unit Analysis resulted in a word per minute count of 82.7. His Correct Information
Unit Count (CIU) was 27. The percentage of CIUs was 60%.
3.2. The therapy dog
The therapy dog was a friendly, 5-year-old Nova Scotia Duck Tolling Retriever named
Paugan. Prior to initiating the AAT program, the dog and handler (the treating speechlanguage pathologist) were evaluated together by a recognized evaluator for Ottawa
Therapy Dogs (OTD), a local chapter of Therapy Dogs International (TDI). This
organization, based in the United States, provides standards of excellence and training to
therapy dog handlers and dogs, as well as insurance protection for its volunteers, like
similar therapy dog organizations. TDI tests an animal primarily for temperament,
carefully assessing the dog’s potential to work safely and comfortably within an
institutionalized setting. Evaluation also includes a veterinary check, proof of vaccinations
and good health. In addition, for insurance purposes because the handler was a
professional, the dog was registered as a volunteer at the hospital, identified to passersby
with a standard photo identification badge.
3.3. The handler
The handler was dual qualified as a speech-language pathologist and certified therapy
dog handler with TDI. As handler, she was obliged under TDI rules to be in full and direct
control of the dog at all times. Outside of the treatment room, the dog was required to be
leashed. The dog and handler worked as a team. She could not ‘lend’ the dog to another
therapist for a treatment session.
3.4. The animal-assisted therapy (AAT) program
Speech therapy sessions on Fridays at The Rehabilitation Centre involve the option of
participation in animal-assisted therapy (AAT), a program created and carried out by this
same clinician. Like all patients with potential to participate in the program, the participant
was carefully screened to determine his suitability. Screening included a set of questions

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provided in both spoken and written form asking whether or not the participant liked dogs,
had allergies to dogs, had fears of dogs and would be interested in speech therapy with the
dog.
Upon completion of this screening tool, signed by the participant and witnessed by his
wife, he was deemed appropriate for AAT. He willingly consented to participate in
once-weekly hour-long AAT sessions involving this clinician, accompanied by her
therapy dog.
AAT sessions, like traditional speech therapy, are individual sessions that are clientbased, goal-directed and charted. Sessions are intended to be enjoyable and relaxed, with
an element of fun provided by the presence of the dog. For research purposes, the
participant agreed to data collection on Fridays only during the walk back to the ward
following AAT sessions.
Typically, patients at this rehabilitation centre return to the ward with the assistance of a
porter. AAT sessions typically end with the dog handler and therapy dog accompanying
each patient back to the ward. No porter is involved.
A double-leash walking technique is used to ensure the safety of the patient and dog.
This technique is as follows: two leashes are attached to the therapy dog’s collar. The
patient is given one leash and is requested to hold onto it and be responsible for walking the
dog back to the ward. The second leash, held by the dog’s handler, is a precaution, should
the patient lose control of the dog. Because many AAT patients are non-ambulatory, the
therapy dog was trained to walk on the left-hand side of a wheelchair.
The goal of this walk is to encourage patients in the AAT program to communicate to
staff, other patients and passersby, therefore affording opportunities for social interaction
and transfer of therapeutic goals.
3.5. Design
Research was carried out on 11 consecutive Friday mornings. The study lasted the
duration of the participant’s inpatient stay at the centre and continued as part of his
outpatient program. Each condition was designed to examine the influences on the
interaction levels of the participant in the presence of a porter, the dog handler (the speechlanguage pathologist), or both the dog handler and dog.
Before initiating any data collection, an observer familiarized herself with the
environment and familiarized patients (including the participant) with her presence. She
met the patient following a speech treatment session and accompanied the patient back to
the ward. Data collection phases of the study began following this initiation portion that
was intended to minimize interference factors.
Condition A of the study occurred during the first two Friday mornings following an
AAT session with the participant. Following completion of the treatment session, the porter
returned the participant to the ward.
Condition B, which constituted weeks 3 and 4 of the study, involved only the dog
handler (e.g. the speech-language pathologist alone, without the dog) who returned the
participant to the ward.
Condition C involved both the dog handler and therapy dog accompanying the
participant back to the ward using the double-leash walking activity described earlier.

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This condition continued for approximately 5 weeks, from week-5 to week-9, in part to
reduce any novelty effect of the dog.
During the last 2 weeks of the study, both dog and handler were removed. This was
intended to increase confidence in the effects being directional to the imposed conditions
and also to dispel any effects of the patient’s intensive, daily speech therapy program as
well as any spontaneous recovery. This last stage, weeks 10 and 11 of the study, returned to
condition A. The porter alone returned the participant to the ward. Throughout the duration
of this investigation, within the four phases (A-B-C-A), the participant was accompanied
by the observer who walked to the right and slightly behind the participant’s wheelchair.
All walks with the participant throughout the duration of these 11 weeks occurred at the
same time and on the same day of each week at the hospital. All observations used the same
route through the centre, from the therapy room on the lower setting of the hospital through
a fixed route of hospital corridors back to the ward.
Observations focused on the overt social-verbal and social-nonverbal behaviors of the
participant only, not conversation partners. Behaviors were chosen on the basis of the
participant’s willingness to communicate freely as per the Hall and Malpus (2000) study.
Social-verbal behaviors included: laughing, attempts to verbalize, automatic speech,
production of single words, production of utterances and production of sentences. Socialnonverbal behaviors included: smiling, gestures to communicate, head nods, eye contact
and attention directed towards the handler, staff or other patients.
Observations were timed and lasted between 2 and 3 min, the duration of time it took to
walk from the therapy room to the ward. Tallies were made of all behaviors observed.
Data were plotted on graphs and analyzed descriptively.

4. Results
The results of the number of verbal and nonverbal behaviors per minute can be found in
Table 1 as well as a graphic representation in Fig. 1. A small increase in verbal behaviors
was noted when the dog handler was introduced in condition B but a marked increase in
Table 1
Observed behaviors per minute and collective means for each experimental condition

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Fig. 1. Verbal and nonverbal scores per minute.

both verbal and nonverbal behaviors is observed in condition C, following the introduction
of the dog. Both observed verbal (3.34) and nonverbal behaviors (1.13) were highest in
condition C. The observed social verbal behaviors ranged from 0/min in week-1 up to 4.7/
min during weeks 7 and 9. Similarly, social nonverbal behaviors ranged from 0/min
throughout weeks 1–4 and week-11 to 1.3/min in weeks 7 and 9. A slight dip occurred for
both social verbal and nonverbal behaviors in week-8. Despite this decline, scores
remained higher or equivalent to those observed in those other weeks when the dog did not
accompany the participant. With the introduction of the dog in week-5, the participant’s
overt social verbal and nonverbal behaviors increased notably. Behaviors declined during
the last 2 weeks when the dog no longer accompanied the patient.
The presence of the therapy dog during the walk back to the ward yielded beneficial
effects for communication, increasing both social-verbal and social-nonverbal behaviors
for the participant. Walking with the leashed dog increased the participant’s opportunities
to communicate with passersby who would pause to pat the dog and chat. The presence of
the dog also seemed to improve the participant’s general sense of cheerfulness and wellbeing, a characteristic that was noted in his collective mean of nonverbal behaviors during
condition C.

5. Discussion
The results of this small-scale study suggest that dogs may, as in other areas outside the
field of communication disorders, serve as catalysts for human communication. The
participant, a shy, quiet gentleman, tended generally not to initiate conversation or to chat
to strangers. In the presence of the therapy dog, impressions are that he became more
animated and outgoing; he willingly introduced the animal to curious strangers who
approached to pat the dog or ask questions about the dog’s breed or personality. He was
notably less passive in his approach to communication during these double leash walks
back to the ward.

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Interestingly too, a hospital slowdown, caused by a winter infectious disease, occurred
during at least 1 week during condition C when dog and dog handler walked the participant
back to the ward. Despite fewer visitors to the hospital, scores during this period remained
consistently higher than during other experimental conditions.
It is interesting to speculate as well on the patterns of these selected behaviors for
investigation in an environment outside of institutionalized settings, such as this
rehabilitation setting. Would a passerby display the same interest and stop to chat to a
person with aphasia or another speech disorder in a more natural environment, such as a
park or street corner, where dogs are permitted and sometimes are plentiful? In these
circumstances, the role of the dog would be much more far reaching than simply being a
companion. Kagan proposes that a person with aphasia can experience a perceived lack of
competency because he is unable to expose his cognitive and social competencies through
the medium of conversation. Kagan (1995) and Kagan and Gailey (1993) suggest that this
occurs due to an interaction of: (1) diminished conversational skills and (2) a diminished
amount of opportunities to engage in conversation. As a result, this lack of ability and
opportunity contributes to hiding their competency and this perceived lack of competency
by others excludes them even more from conversations and social activities. A negative
cycle is therefore created, isolating the person with aphasia (Kagan, 1995). The case study
reported here gives impetus to a field of research where dogs may be studied as catalyst for
breaking this negative cycle of social interaction in persons with aphasia.

6. Conclusion
Although evidence exists outside the field, little research to date has been carried out
within the area of communication disorders on the role that companion and working dogs
offer to individuals with aphasia. This single subject study, carried out in a Canadian
rehabilitation setting with a stroke survivor receiving speech and language therapy,
suggests that the presence of a therapy dog may be a catalyst to improve both verbal and
nonverbal communication skills.

Acknowledgements
This study was completed in partial fulfillment of the degree of Master’s of Health
Science, given to the first author. The authors would like to thank the participant with
aphasia who took part in this project.
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