Paola Carolina Cortés Rodríguez and Enrique Roche. Miguel Hernández University of Elche (Spain)
Everybody needs sensorial stimulation in order to understand the world that surrounds us. The way that we obtain information from our environment is through our senses (sight, hearing, touch, taste and smell) and movement. Our senses are in constant communication with our surroundings. The colour of a wall, the feel of a chair, the intensity of a light, the smells, or the wind that enters through an open window are examples of sensations that we can experience all at the same time. If we receive too many stimulations we can be overwhelmed. However, too little stimulation can make us lose interest in our surroundings and therefore lose the ability to do things. Nowadays it is known that depriving of one´s sensorial stimulation and activity has a devastating effect on our wellbeing and health.
The elderly are more limited in their physical and cognitive capabilities, requiring them to participate in activities that provide them multisensorial stimulation, as they are not capable of accessing these types of stimulations on their own. An adequate level of sensorial stimulation can help alleviate stress and boredom. Also, the participation in an activity implies an act of communication, improving their sense of comfort and wellbeing.
During the end of the 19th century and beginning of the 20th, the Italian educator Maria Montessori developed a teaching method based on the experience of working with children that had severe mental disabilities. In the 1990s the occupational therapist Patricia Wilbarger developed a new approach in order to confront the sensorial defensive attitude, which is described as “the constellation of symptoms that imply reactions to avoid experiencing any sensorial modality.” Wilbarger coined the term “sensorial diet” to describe a treatment programme to help family members of children with mental disabilities in order to adapt to the activities and satisfy the sensorial needs of the children, improving their functional behaviour.
However, the advances in sensorial therapy have only been in children. Nowadays this type of therapy is being used in adults that suffer from certain kinds of dementia or autism and are in nursing homes and day-care centres.
The sensorial rooms or Multi-sensorial Environments (MSE), are spaces to enjoy a variety of experiences and where soft stimulation of the senses (sight, hearing, touch, taste and smell, along with movement) can be experienced in a controlled manner. The stimulation can be increased or decreased depending on the therapeutic interests and necessities of the user. These rooms offer a variety of activities, for sensorial stimulation as well as for relaxation.
The MSE concept, also known as Snoezelen®, originated in the beginning of the 80s in Holland by two therapists, Ad Verheul and Jan Hulsegge. MSE began as a means to provide amusement and rest for adults with severe neurological disabilities. The first MSE were tents furnished with sensorial supports and equipment designed to stimulate the primary senses, creating a multisensorial experience for the visitors. The answer to the installations was so positive that it gave rise to the construction of the first permanent MSE in the year 1989. Currently, MSEs can be found internationally in hospitals, nursing homes, day-care centres, residences, households, schools and even prisons.
Initially, MSE was used for the amusement of adults with learning disabilities. Now, they are also applied with success to other users, including people with cognitive and physical difficulties such as autism, brain and spinal cord injury, stroke, and those with limited movement, eyesight and/or hearing. The MSE offers the opportunity to perform an activity that is free of the cognitive demands in a space that can be used by the caretakers, as well as family members.
The conventional MSE contains a large variety of equipment to stimulate the senses, such as: bubble columns, thematic image projectors, fibre optics of various colours (to stimulate sight), sound system and CD player (to stimulate hearing), fibre optics for braiding (stimulates touch), aromas distributors (stimulates smell), waterbeds and vibrating chairs (stimulates movement), and equipment with on/off switches (to provoke interactions), among other things.
Although little is known concerning how or why MSE works, research studies and tests have demonstrated that individuals with dementia find them pleasant and relaxing. After spending some time in the sensorial room, the patients in their last stages of dementia show positive signs of change in their behaviour and mood, as well as increased attention to their surroundings.
A common misconception of the multisensorial stimulation is that it is mainly centred in visual stimulation. However, all the senses should be considered. These include touch, hearing, smell and taste, along with movement. Sight is an often overvalued sense, while the sense of touch is given little attention, as there are an insufficient variety of materials and objects to touch and explore. Also, the senses of smell, taste and hearing are highly unexplored. Proprioception (orientation and balance) stimulation and kinaesthetic (position and movement of arms and legs) are mainly uncared for.
An adequate solution is to use designed multisensorial equipment, elements and materials. For example, musical instruments or scented pillows made with different materials offer a more extensive opportunity to explore visual, tactile, hearing, and olfactory stimulations while promoting movement.
The light, images, colour, materials of different optic qualities (for example, shiny, reflecting, transparent) are used to stimulate sight. Materials and objects that present different surfaces, textures and sensation; the temperature, wind, and vibration are elements that stimulate touch. As for hearing stimulation, it is possible to use music, sounds, thematic themes (bird singing, waves crashing), instruments and everyday utensils (dishes, textiles). The essences from aromatherapy, bags with flowers, lavender or animal smells stimulate olfaction. Sensorial stimulation can be assisted with a variety of activities. Smell can be actively stimulated through the preparation of foods with characteristic smells: pots full of spices such as cinnamon or clove, herbs such as mint, lemon juice or shavings, etc. Also, foods can stimulate taste when consumed. Beverages (cold or hot), foods with characteristic textures (popcorn and royal jelly), fruits, pastries with bright colours are examples of multisensorial foods that not only are for taste, but also for texture and colour, stimulating other senses. It is very important in sensorial stimulation to know the individual preferences of the subjects and their past experiences in order to properly adapt each work session.
The sense of taste is a commonly forgotten component in the multisensorial experience. However, it is a powerful way to understand what is happening in our surroundings. Taste can cause memories, as well as emotions. Taste is also very personal, therefore it is very important for the evaluator to have profound information regarding the likes and dislikes of the individual.
Food textures is also a stimulating element. For example, creamy textures can be soothing (savouring a piece of chocolate). The subjects can also have strong responses to certain textures, therefore it is very important to consider the personal tastes. Stimulating taste helps the subjects to respond and remember sensations that they had with respect to food, contributing to a better nutritional state and therefore better health. A sensorial session can be used to encourage the participants to drink more liquids during their stay, improve their deglutition (in cases where there is dysphagia), as well as increase autonomy and avoid food rejection during their meals.
The GYMSEN project is financed by the Erasmus+ Programme of the European Union. This project focuses on sensorial stimulation of the elderly in relation to food, in order to improve their nutritional state and in the long term their quality of life. GYMSEN is a consortium of various associations and institutions:
- University Miguel Hernández (UMH): GYMSEN group leader that has been working for over 10 years in the project with the University of Experience. In this project, the elderly attend classes of a variety of topics as well as participate in activities organised by the university. We aspire that with this course, the intellectual active elders may experience the sensorial stimulation workshops that offer GYMSEN.
- AINIA and SP: These are technological centres in Spain and Sweden with renowned experience in terms of food consumption, tastes and appetites of consumers along with sensorial stimulation.
- AAADRD: The Athens Association of Alzheimer´s Disease and Related Disorders, who will use GYMSEN workshops on Alzheimer´s Disease patients.
- ANS: This Italian association focuses on nursing homes for the elderly, and will bring GYMSEN workshops to these centres.
- ERA: This institution in the Czech Republic proposes GYMSEN workshops focused on intellectual inactive elders.
FOR MORE INFORMATION
- Web page GYMSEN: http://www.gymsen.eu
- Brand, A. Gaudion, K. Exploring sensory preferences living environments for adults with autism. (2012), UK.
- Collier, L., Jacob, A. How to make a sensory room for people living with dementia. A Guide Book. (2014), UK.
- Collier, L., Jacob, A. “How to make a Sensory Room for people living with dementia” – developing design guidance for health care practitioners. Proceedings of the 3rd European conference on Design4Health. (2015), UK.
- Treadaway, K., Kenning. G., Coleman, S. Sensor e-Textiles: Designing for persons with late stage dementia. Proceedings of the 3rd European conference on Design4Health. (2015), UK.