The Sensiks Sensory Reality Pod is a space for enjoying a variety of sensory experiences and where gentle stimulation of the senses (sight, sound, touch, taste, smell and movement) can be provided in a controlled way. Stimulation can be increased or decreased to match the interests and therapeutic needs of the user.
CASE STUDY: DEMENTIA & SENSORY STIMULATION
eople with dementia and their needs
The term ‘dementia’ describes progressive disorders affecting the brain such as Alzheimer’s disease, vascular dementia and dementia with Lewy bodies. These conditions present problems with thinking, mood, behavior, and the ability to take part in everyday activity and leisure.
If no suitable activities are provided and people living with dementia have nothing to do, they might become increasingly isolated, frustrated, bored and unhappy. This is reflected in people walking around and searching, or becoming agitated and emotional distressed. The absence of activities also affects their ability to maintain everyday skills such as self-care.
Medication such as neuroleptics and other sedatives are often used to control these problems. Although medication achieves short-term results it frequently causes side effects such as drowsiness, which makes the problem worse as it reduces independence. Given these risks, good clinical practice should first exclude the possibility that these problems have a physical cause (e.g. infection or pain) and engage
in non-pharmacological approaches before considering medication. Stimulation and activity suitable and appropriate for the individual will help keep the person active and included which also helps both to maintain function and cognition, and to manage and moderate mood and behavior. As with medication, activities must be tailored to meet individual needs.
However, choosing the most suitable type of activity for people in the mid to late stages of the disease is challenging. Given those people may not be able to participate in hobbies enjoyed in the past, it may be the sensory side of that activity that needs to be supported.
For example, a woman who enjoyed baking may experience pleasure being able to knead dough and/or to taste the finished product, despite not being able to complete the activity as a whole. Identifying these parts is critical in constructing an activity and an environment that is suitable and desirable for the individual. This form of sensory activity may also provide a level of stimulation, which increases awareness and attention due to the simplicity of the task. Matching the sensory demand of the activity with a well-designed environment will help the person with dementia to take part. For residents with specific medical requirements a relevant health care professional needs to be consulted before following the advice in this guide.
Examples of sensory stimulation for each of the senses applicable in dementia care (the “Sensory Tool Kit”):
- Sight: light, images, color, material of various optical qualities (e.g. shiny, reflective, transparent)
- Touch: materials and objects featuring various surfaces, texture and feel, temperature, breeze, vibration
- Taste: drinks (hot or cold), stimulating food/snacks (e.g. citrus fruits, sherbet or peppermint), textured foods (e.g. popcorn and jelly)
- Smell: aromatherapy scents and smell pots diffuser, lavender bag, everyday items, various material, food, flowers, animals, skin and fur
- Sound: music, sound-scape, environmental themes (birdsong, sea waves), instruments, every day items (cutlery, textiles)
- Movement: different seating position, rocking chair, bean bag, laying down, stimulating head and arm movements
What is multi sensory stimulation?
Everyone needs sensory stimulation in order to comprehend the world around them. The only way we can get information into our brains is through our senses; sight, sound, touch, taste, smell and movement. If we have too much stimulation we can become easily overwhelmed (e.g. being in a noisy, busy shopping center for too long). If we have too little we lose interest in our surroundings and lose the ability to do things (e.g. people with no stimulation will often sleep to pass time and miss out on activity). Today it is recognized that deprivation of sensory stimulation and appropriate activity has a devastating impact on our wellbeing and health.
Older people in particular who are limited in their physical and cognitive abilities, need to be offered and helped to engage in activity that provides multi-sensory stimulation, as they may not be able to access this kind of stimulation by themselves. The right level of sensory stimulation helps to relieve stress and boredom; to engage in activity also involves an act of communication that enhances the feeling of comfort and wellbeing.
Stimulation of the senses includes sight, touch, taste, smell, sound and movement (proprioception – where our body is in space, and vestibular awareness – how fast we are moving and in what direction).
How much stimulation a person can cope with depends on whether they are a sensory seeker or a sensory avoider. A sensory seeker can cope with higher levels of stimulation with multiple stimuli. If they are not getting enough stimulation they may well create their own – for example, dismantling the TV, going into other people’s rooms.
If they are a sensory avoider they may find the environment too stimulating so try and get away from it – for example, trying to leave the building or challenging another resident who is calling out. Therefore a Sensiks Sensory Pod should include a “Sensory Tool Kit” (examples listed in the box on the right) to provide both intense and gentle stimulation.
Benefits Sensiks Sensory Pod
The Sensiks Sensory Pod, also called Multi Sensory Environment (MSE), is a space for enjoying a variety of sensory experiences and where gentle stimulation of the senses (sight, sound, touch, taste, smell and movement) can be provided in a controlled way. Stimulation can be increased or decreased to match the interests and therapeutic needs of the user. Such spaces, and how they are equipped, offer a range of activities that can either be sensory stimulating or calming in their effects.
The concept originated in The Netherlands in the early 1980s. Initially, the MSE was used for leisure activities involving adults with learning disabilities. Nowadays it is also successfully applied in relation to other user groups including people with cognitive and physical impairments such as autism, acquired head injuries, stroke, and those with limitations of movement, vision and/or hearing. The MSE offers the opportunity for an activity that is free from cognitive demands in a space that can be used by care workers as well as family members and informal carers.
The conventional MSE, as provided by industry suppliers, contains a variety of equipment to stimulate the senses such as: bubble columns, solar projector casting themed images, coloured optic fibres (for stimulating sight), CD player/sound system (sound), optic fibres to stroke and plait (touch), aroma distributor (smell), waterbeds and vibrating chairs (movement), equipment featuring switches (interaction).
Although little is actually known about how or why MSEs / Sensiks Sensory Pods work, research studies and anecdotal evidence have shown that people with dementia find them enjoyable and relaxing. After spending time in a Sensiks Sensory Pod, residents in the later stages of dementia show positive changes in mood and behavior, and also an increase in attention to their surroundings. Staff feels that these improvements help with their relationship with the residents and their daily work.
Though it seems that these environments and activities have the potential to improve a person’s abilities and wellbeing, it has also been reported that Sensiks Sensory Pods do not always live up to expectations and staff stop using them.
The reason for this might be that often, when setting the space up, little thought is given to the design itself and how this environment is going to be used. As a consequence, such spaces do not always work for people with dementia and their care workers because aesthetics and functionality of the spaces are not satisfying and appropriate.
The success of these spaces is very much influenced by what staff think the room is for, how it is understood and consequently used by care workers – not just in times of a resident’s distress but also as a means of positively enhancing peoples’ lives. Multi sensory stimulation should not be limited to a particular space, it should be provided throughout the home in common areas (including garden) and also residents’ bedrooms.
First of all, the care home should look like a home and less like an institution. A stimulating but comfortable environment can be created through a considered and appropriate use of color, wall paper, attractive furniture, art work / images, appropriate decoration, sensory corridors, and the introduction of nature through aquarium, pets, water features, plants and small trees.
For people with dementia a sensory stimulating environment may facilitate interaction between them and their career enhancing communication on a verbal and non-verbal level. Increasing sensory awareness also supports information processing and raises awareness of the general environment. Sensory stimulating surroundings help working out where you are by the sensory cues around you, for example: ‘It is steamy, I can smell soap, I could be in a bathroom’ / ‘It is hot, I can smell onions, there are plates and cutlery – it must be lunchtime’).
However, the provision of a generally stimulating and comfortable environment does not necessarily eliminate the potential need for a specific multi sensory space – whether it is a semi-open area or corner embedded in the general living environment or a multi Sensiks Sensory Pod where it is possible to close the door for focused activities and sensory sessions.
Where possible a multi sensory space should always be accessible to residents at any time – whether it is a room (door should be open or unlocked) or a sensory area. This ensures that residents can use the space on their own whenever they want to, giving them choice and control. It also makes for a more cost effective approach, which does not rely on staff having to take the residents to the space. The room/area should be set up in such a way that it is safe for the residents to access if unsupervised. Potentially harmful items or expensive equipment should be stored/locked away or secured in such a way that it cannot be dismantled or broken by the residents. Ideally the room/space should be located near the lounge where care workers can easily support the residents using the multi sensory space.
Exploring the environment will always come with an element of risk. Each sensory experience should be assessed to allow each individual to challenge and explore. This level of risk will
be different for each resident and it is the team’s responsibility to ensure personal autonomy and dignity are maintained whilst high risk exposure is reduced. Using guidelines such as those in the PAL with help reduce risk whilst maintaining an appropriate level of engagement.
Feeling comfortable and safe
The space you want to create should be an environment where residents feel comfortable, safe and secure. It should be an intimate, contained and quiet space with minimized or zero capacity for disturbance or distraction, neither visually nor through loud noise or other people walking in and out. Providing a soft, warm and cozy atmosphere is vital.
Using low-level sensory stimulation will activate the parasympathetic nervous system: inducing a state of calm. This will help the residents to relax and will reduce stress and anxiety, and subsequently enable them to better focus on activities offered.
Meaningful and familiar
Apart from stimulating the senses your Sensiks Sensory Pod / multi sensory space should be equipped and designed in such a way that it can provide familiar, personal and appropriate experiences that are relevant to the resident’s life and stage of dementia. Everyday objects, e.g. set of keys or a little bell, and/ or tailor-made objects, e.g. textile books or sensory cushions, can trigger off memories or start a conversation. The design should create opportunities for exploring and engaging in appropriate activity giving the person a sense of purpose. Making the room feel familiar will help with transition into the room and residents will be more motivated
Multi sensory experience
All the senses need to be addressed! This includes sight, touch, sound, smell, taste and movement. Our study has shown that the visual sense is often overvalued, in some cases even over-stimulated. In contrast, the provision of tactile stimuli is limited as there is not enough variety of material and objects to touch and explore. Similarly there
is often not enough stimulation of hearing, smell and taste. Stimulating the vestibular (moving in space, orientation and balance) and kinesthetic sense (position and movement of arms and legs) is mostly neglected.
A good solution here is to use equipment, items and material that are multi sensory in design. For example, music instruments or scented cushions made from various materials provide a wider opportunity to explore visual, tactile, audio and olfactory (smell) stimulation and encourage movement. Many kinds of food are also multi sensory such as fruits, colorful cake or sorbet providing not just taste but also texture and color.
Combining various stimuli addressing different senses under a particular theme can create meaningful multi sensory and reminiscent experiences. For example a walk on the coast: the sound of waves and seagulls, a breeze, a video showing the sea and the beach, sand and some shells to touch. This can create a virtual environment bringing the experience of the seaside indoors.
This can be considered as part of thermoregulation as well as orientation, in essence another sense. It helps us to orientate to our environment and can stimulate reminiscence, which can lead to increased wellbeing and increased awareness. For example, a warm room with sounds of the seashore might suggest being on holiday.
Auditory stimulation is very effective for mood enhancement, relaxation, and cognition. It includes a wide range of sounds, ranging from natural sound (e.g. birdsong, waterfall, urban environment) to generated sound such as music. Both can be enjoyed life or played back through a sound system.
A multi sensory space should provide both, a good sound system with CD player as well as items that produce life sounds such as musical instruments or water features.
Olfactory stimulation can be facilitated through a wide range of actions and activities. Smell can be actively stimulated through a bespoke smelling session or aromatherapy session, or just be in the background providing a pleasant and fresh atmosphere when entering the sensory space.
The sense of taste is often under-used as a sensory component of a multi sensory experience; however, it is a powerful way of understanding what is happening around us. Taste can provoke memories as well as emotions. Taste is also highly personal so it needs to be ensured that staff has a clear understanding of likes and dislikes of the individual.
Texture is also an element that provokes response. For example, soft creamy textures can be soothing (sucking chocolate).
Residents may also have strong responses to certain textures so, again, care needs to be taken. Examples of different tastes and textures are given below.
Stimulating the sense of taste is not about eating and feeding. The goal is to provide stimulation: small tasters and snacks for comfort and enjoyment to encourage residents to respond and reminisce. Offer something that people would see as a luxury or a treat, not the everyday taste. A sensory session can also be used to encourage residents to have more fluids within this time. Care needs to be taken with participants who have specific dietary needs or swallowing difficulties. A health care professional might need to be consulted for further advice.
Movement (vestibular and kinesthetic sense)
The vestibular sense is the sense that provides us with information about our movement in space. It is responsible for spatial orientation and balance – for creating an awareness of the location of our heads and bodies in relation to the ground. The kinesthetic sense (also called ‘proprioception’) is the sense of the position and movement of our arms and legs in relation to one another. It tells us where our body parts are located at that moment, and how much strength we need to exert when completing various task.
Movement and different body positions address both senses. Moving our bodies can either stimulate or relax. Spinning or random movements tend to be stimulating whereas linear movements are relaxing, for example, we rock a baby to help it sleep but dancing energetically is stimulating.
Stimulation and Relaxation
A Sensiks Sensory Pod should be seen as a sensory toolbox with a number of different items to stimulate the senses at different levels of intensity. For example, bright lights to stimulate and soft low level lighting to relax. The person setting up the room also needs to remember that what relaxes one person may stimulate another. A person who is sensitive to stimulation is likely to respond quicker. By completing an in depth personal life story staff will be aware of what things stimulate or relax each resident.
The selection of each piece of sensory equipment or item should then be based on that person’s interests and needs. Outcomes from each sensory session need to be recorded alongside what has been stimulating or relaxing so that other staff will know which pieces of equipment or item and/or which sensory activity work best at either stimulating or relaxing.
By having a Sensiks Sensory Pod/Space it is possible to create either a relaxing or a stimulating environment. Below are some suggestions of relaxing and stimulating pieces of equipment.
Control and Interaction
Interaction and engagement at the right level for the individual is important as it promotes brain activity and helps the person maintain interaction skills such as learning and communication.
Doing things for you also increases confidence and feelings of self worth. Hence residents using the Sensory Space/Room should be allowed and encouraged to choose sound / music, color and intensity of light, imagery etc. themselves. It is about giving somebody the opportunity and empowerment to choose what to explore and at somebody’s own pace.
Being able to control the stimulation give a sense of mastery over the environment. This facilitates the user to modify the amount and type of stimulation they receive and help prevent them becoming over-stimulated.
The way care workers interact and communicate with the person with dementia is critical in maintaining dignity: if the interaction is appropriate and the piece of equipment is targeted at the right level of ability then dignity is maintained. Focus on what kind of stimulation it provides and reflect on how it might make you feel.
A validation approach can also be used when presenting items or equipment by talking about what that type of stimulation might remind you of. For example, the optic fibre spray is twinkling: it reminds me of Christmas lights, how did you spend Christmas with your family?
Staff needs to be clear about what is to be achieved by the piece of equipment: for example is a nursing chair appropriate for older people? This type of chair providing a linear rocking action (suitable for relaxation) might be considered for the Sensiks Sensory Pod as its design reduces the chance of the individual falling out. However, if it is referred to as the nursing chair this could be perceived as inappropriate.
Apart from the issue surrounding aesthetics and connotation, the usability of sensory equipment and items is of high importance too.
A multi sensory space needs to be set up and designed in such a way that sensory equipment and items to be explored are in easy reach or/and sight for the residents. As many of the residents might be bound to a wheelchair ‘eye level’ for them is lower then for a person walking or standing. For similar reasons a person might not be able to bend down. So items placed on the floor would be out of reach for them.
Also, equipment should be ergonomically designed to suit the abilities of older people with physical limitations and not able to grab and hold things easily anymore. This is particularly important if integrated switches are employed for user control.