Synchrony is a happymaker

An interview with Richard Griffioen by Ries Vriend.

Nederlands

Richard Griffioen (1957) has a master’s in psychology, a PhD in the field of human-animal interactions, is a practicing physiotherapist, manual therapist and acupuncturist; and is professor of Animal Assisted Interventions at the Aeres University of Applied Sciences in Dronten since April 2021. Richard is a board member of the International Association of Human-Animal Interaction Organizations.

Richard has a son, Sam, with Down syndrome. Richard is founder and chairman of the Sam Foundation. The Sam Foundation has been around for more than twenty years and has helped hundreds of children with Down syndrome and autism improve their communication skills, through animal-assisted therapy. The animal assisted therapy program of The Sam Foundation is called “Livelier with Animals”. The Sam Foundation has also been successful with mixed-reality animal assisted therapy since 2017.  With the help of Virtual Reality glasses, children go through a joyful development in a swimming pool.

In this interview, I try to figure out how Richard manages to get so much done. On a friend’s day of The Sam Foundation, I was recently able to participate in swimming with their virtual dolphins. It was an unforgettable experience that is very relaxing and helps to be open. Since then, I’ve become interested in Richard’s ideas about developing Virtual Reality and Mixed Reality apps that can be applied as an alternative to animal assisted therapy programs.

My first question is: Suppose I have a child with Down’s syndrome. What does my world look like?

Richard: 25 years ago when my son Sam was born I had to discover everything myself. In The Netherlands, there are now the Down Syndrome Foundation and the Dutch Autism Association.

Why are the two grouped together for therapies? Down patients often also have autism; in about 30% of cases. So that’s an intersection. That ranges from mild to severe. Furthermore, Down and autism are the two largest groups of children with “non-typical” development, who have a disability. They are also the two best organized parent organizations in the Netherlands. About 1 in 220 (0.45%) was a birth with Down. Now goes down because these pregnancies are often aborted. Figure 2016 is 0.1%. Autism is 3% of births (regarded as severe, so with a developmental delay). With autism, diagnosis only comes later in life, from the age of 4. At that stage, parents have already completed a difficult road. With Down it is immediately visible.

Today, there is a circle of the Down Syndrome Foundation in every Dutch city. There you can request information; it’s a source of information for everything. That foundation is paid for from a parental contribution, perhaps a subsidy. In addition, there are Down teams in six Dutch hospitals. This is a multidisciplinary team with a cardiologist, paediatrician, occupational therapist, speech therapist, physiotherapist and sometimes a remedial educationalist. Usually no psychologist, but that is available to the parents. As new parents, you approach the Down team for guidance. All other info is via the foundation and their magazine. The Dutch Autism Association also has a good magazine.

Relaxation, concentration, social interaction, and speech development are very important skills to work on. Delayed development in speech and social interaction occurs in both groups. Concentration and relaxation are a layer below that. Without that, you can’t build social interaction.

At the real-life dolphin assisted therapy program by the Sam Foundation, this was the greatest good: improving concentration and relaxation.  With the new Virtual Reality sessions “Swimming with Dolphins” you notice that participants in the pool also really relax, which is an important factor in why it works.

For children with Down, speech therapy and physiotherapy are very important tools. The expectation with Down syndrome is that the child will experience a delayed development. This leads to problems in behavior: fear of failure and being stuck in stereotypical behavior. There are few solutions for this in regular care. They see it, but there aren’t that many effective mainstream solutions. With autism, it is mainly addressed using behavioral therapy. In the mainstream, this is often addressed very cognitively, and that route is very difficult for this group.

Sam received very good pediatric physiotherapy, also pre-verbal speech therapy. But, when he swam with actual dolphins in Florida, he suddenly spoke 25 words and overcame fear of failure to walk stairs. This can be explained in two ways. On the one hand by the relaxation that swimming with dolphins generates. And on the other hand, by positive self-affirmation and the sense of wonder to be in the water and with the dolphin. The child felt positively challenged to do something because the reward was very big and the experience very positive. This is a basic principle of behavioral therapy, applied in a special way.

There’s a very important underlying thing going on. The nonverbal principle of working with animals and thus the attunement of the child with the animal. This is actually a deeper layer than the cognitive. The nonverbal supports the cognitive. It is this non-verbal therapy that is very powerful in supplementing what mainstream care has to offer.

Richard, you started filling the gap in a non-cognitive way. What name do you use for this approach? Richard: “Synchrony”, this means being attuned. It is a form of communication. Very important in this context is attachment. Many children in our target group have attachment disorders, being unable to enter an open attitude.

With Virtual Reality we can also support that. For example, by relaxing in the water and with VR glasses on. You can practice social interaction between the moments of swimming and wearing glasses. The child is then more relaxed and open to practice.

What are the tools for adults with Down? Richard doesn’t have much of a picture of it yet. He works with children up to 18. But if, for example, a 24-year-old has the self-reliance of a 3-year-old, then something is often fit in. In practice, the adults are all in projects for assisted living or in residential groups. They do a lot of activities there. There they settle for what the level is. That could be a huge missed opportunity. With Down you often experience accelerated aging, also Alzheimer. Animal assisted activities might be meaningful there.

Research and programs

In the Netherlands, many farms have refocused to providing daytime activities to people with disabilities. These are called care farms. Richard has already been approached by care farms that would like to start or improve animal assisted interventions. Richard then wants to know what can be facilitated there; the facilities must be suitable. The questions that live in practice must be inventoried. Assistant dogs are a good example. The standing in society of assistant dogs should be improved. They are like dogs that accompany the blind, but for different categories of disability. The need is to gain access to public environments (restaurant, transport, etc.) with an assistant dog. The acceptance and an auditing standard for assistant dogs is not there yet.

Who are your partners for Animal Assisted Interventions (AAI) VR research?

The Dolphin Swim Club is an independent company that created the Virtual Reality video used in the VR swimming with Dolphins program at The Sam Foundation. The therapy program around it was developed by Richard and the Sam Foundation. Richard noticed an article in a national newspaper about the Dolphin Swim club in 2017. Richard and Marcel of The Sam Foundation approached them and offered to facilitate a therapy setting to be able to work with the equipment.

The VR video of Dolphin Swim Club has already been scientifically assessed, including at the University of Groningen and Harvard. People with chronic pain (such as burns) can relax fantastically with it. VR therapy for depression also works. It also is applied to medical staff who work very hard and have responsible work. Setup a room with VR equipment and you have a tool for helping prevention of failure and burnout.

Steffie van der Steen is a Professor at the University of Groningen. She is an important partner for Richard’s lectorate and the development of the Virtual Reality applications. They will work together to apply for a grant.

Karin Hediger is the new professor of AAI at the Open University in Heerlen. She is also a professor at the University of Basel. Karin succeeds Marie Jose Enders at the Open University, who is retiring. Karin Hediger recently submitted an EU budget application for an AAI VR project, but that has not been granted. Karin is aiming for more research into dogs, robot dogs and VR dogs. Her starting point is that a lot of effect research has already been done; its well known that it works. She would now like to investigate what the predictive properties are that achieve the positive effect. If you can validate the predictive value, you can focus the therapy much more. Such research certainly needs to be carried out, it can also be a collaboration between University of Basel, Open University and Aeres University of Applied Sciences.

In the past (2018), The Sam Foundation has collaborated with the University of Milan. This is where the “Smart Dolphin” project ran, that unfortunately fell silent when there was no more budget left. It’s compelling, nonetheless. They were working towards a Dolphin Dome; a dome with dolphins projected on the walls, a sandy bottom and a bath containing a Smart Dolphin.

Objectives of the Animal Assisted Interventions Virtual Reality program

• Translate the effect of therapeutic work with actual animals such as dogs and horses to VR, making it more accessible and at a lower cost.
• Embed these apps in therapy programs aimed at improving social interaction and communication.
• That many children and young adults achieve an improvement in their quality of life.
• That parents can participate in the program

Richard on the Relevance of the program

Psychosocial development, especially social interaction, and communication (good speech development) and being able to relax and concentrate is important for the children in our target group (children with Down syndrome and children with Autism). It enables them to be confident.

This is best addressed in a safe environment where they can actively practice with a relaxed posture. Our previous research shows that animal-assisted interventions can provide this safe context and have a positive effect on social skills (Griffioen et al., 2020). Many parents are therefore looking for help from animal assisted intervention therapists. Unfortunately, not all therapists are trained to work with these audiences.

The challenge is therefore to build and maintain a program to strengthen this field. The children need to be provided with a safe learning environment.

Virtual Reality can offer an important solution here. The “Swimming with Dolphins” VR-application at the Sam Foundation is inspired by its 20 years of experience with real-life dolphin assisted interventions. These interventions are known to have a positive effect on social skills and the ability to relax.

When the children attune better through this intervention, and thereby develop better social skills, they become happier.

Within our VR environment in the swimming pool, the children relax and therefore concentrate better, which in turn leads to improved social interaction and communication. VR is not just an electronic environment, it is interactive (Freeman et al., 2017). Without anyone telling them what to do, they soon swim around for minutes looking for interaction with the dolphins. This makes it less stressful than some other exercises or therapies. The first effects of VR programs with animals on relaxation and stress reduction have already been demonstrated (Report Eén Vandaag: Schrikkema, 2017), (Van der Steen, 2021).

The Sam Foundation

Who is who and what is the general background?

Board:

• Professor Dr. Richard Griffioen is the chairman and founder
• Jacqueline Knapen is treasurer. She is a tax lawyer. From day 1 in the board. Family friend. Previously, she was on the advisory board.
• Drs. Marcel Clerx. Entrepreneur. Studied economics in Tilburg. Startup entrepreneur. Board member. Gives feedback, is a sounding board and is a hands-on project man. Marcel can sell.
• Roger Muuse. Board member. Entrepreneur. Known Richard for 30 years. Friend of the family. Quick calculator. Thinks in solutions. Roger and Richard have been the pioneers of The Sam Foundation. Roger can organize.

Staff:

• Illona de Groot. Very important; in the execution, the VR project relies on her. Physiotherapist.
• Saskia Hoogervorst. Pediatric physiotherapist.
• Jan Rinckes. Dive master at the VR swimming program.
• Juna Griffioen. Indispensable; can handle both children and equipment.
• Carmen Maurer. Pedagogue and 1st person at the therapeutic program at petting zoos. Also been involved for a long time. Already 4 years at the foundation. She runs the “Livelier with Animals” project at the petting zoo in Ouwehands Zoo, together with the Onky Donky foundation.
• Margriet Spiering. Manages the petting zoo in Amstelveen where the program “Livelier with Animals” also runs.

The Sam Foundation had board of a advisors. People from all kinds of fields. There are still a number of people involved and available for advice. But it’s mature now and the board doesn’t need a board of advice anymore. There are no more periodic meetings with the advisory board. Ries: perhaps another advisory board is needed to help scale up the programs?

The Sam Foundation hires professional contractors. The Sam Foundation was an employer for some time but currently only hires professionals because of the efficiency and risk. Currently, a professional receives a fee of 50 euros per hour plus travel costs. It would be fair if this could go to 75 euros but there is little money. A volunteer receives a maximum of 1500 euros per year. The rates are a board decision.

The ambition is to scale up the program “Livelier with Animals” from 1 to 2 locations in the Netherlands to approximately 12 so that more children in the target group can be reached. A VR project is Curaçao also requested; another foundation is already working there with a horse assisted interventions aimed at children with autism and it would like to expand its capacity.

How does The Sam Foundation get money? Parents pay a contribution. 200 euros for 10 sessions. 10 or 12 sessions gives the best outcome. The rest comes from fundraising. Sam Foundation does not receive any government subsidies at this time. It relies on a very small network of donors. It is very difficult to maintain this. Donations and sponsorships are very important to the Sam Foundation. Sponsors include:

• The Johan Cruyff foundation with a fixed amount per year or a company with a one-off sponsorship.
• The Riki Foundation. rikistichting.nl.

More sponsors and donors are needed!

Lectorate Animal Assisted Interventions at Aeres Hogeschool

The brand new lectorate is vulnerable. The professor must raise funds for the projects and research. Approximately 50K – 100K per year. For each project there’s usually a senior researcher and a project manager in that budget. Costs for reimbursement to students are their expenses only. From the project budget, the professor is compensated for hours spent on coaching. “In kind” the university participates in the project’s funding: typically 10K. Potential government project subsidies are the Kiem subsidy at approximately 30K, or the MKB-Raak subsidy at approximately 300K. Applying for a subsidy takes a lot of time. Richard is still looking for about 100K of financing for the next 2 years.
Richard is now working on the lectorate plan, research projects and curricula.

The research programs include:

• “Livelier with Animals” from Sam Foundation
• AAI Virtual Reality
• Assistance Dogs
• “Man and Horse”; a project that is running in Groningen in which inmates receive therapy with the help of horses.

Options for research programs and projects include:

• Assistance dogs; research their employability. Bulters Mekke assistance dogs is one of the preferred projects. bultersmekke.nl
• Building a toolkit
  • Instructional material for workshops (franchise material)
  • Prevention of disease transmission between humans and animals; hygiene in this area
  • Animal welfare guarantees
• Rehabilitation of traffic accident victims and people with post traumatic stress syndrome. Emotionally and mentally with the help of horses and/or dogs.
• Visiting Assistance Dogs and/or robotics with which you can go to a healthcare institution; visiting assistance dogs in a school that has many children with autism.
• Reading-out-loud programs with an assistance dog present; the child reading to the dog can make all the difference.
• Setup of an auditing standard for horse assisted therapy and coaching in youth care