(c) Fornes, 2009 1

Partial proceeds from this training goes to the Hidden Angel Foundation

Multi Sensory Environment (MSE) TrainingSENSORIUM 5

11/8/2009

SENSORIUM 5

The FacilitatorIdentifying the needs of the userIntroducing the Room and Equipment Protocol

Know clientHave empathyBuild trust

Plan the session Observe closely

Allow client to choose Read signals

Remain connected Remain silent unless

spoken toRespect client’s wishesReinforce positive activitiesRemove from negative

activitiesTake timeBuild relations

CommunicateUnderstanding

CAREGIVER

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“... a sensitive, caring, non-directive approach in which the atmosphere of safety and security is encouraged. The enabler and client will share a common, positive emotional experience during the activity. There is no formal focus upon therapeutic outcome – rather the focus is to assist users to gain maximum pleasure from the activity that they and the enabler are involved in.”

Louise Haggar

THE ENABLING APPROACH

CAREGIVER

• Find a ‘champion’ to lead effort• Appoint multi-disciplinary task force• Appoint individual with direct responsibility for usage, policy and backup• Provide adequate training to all caregivers• Train most receptive group of staff first• Involve maintenance staff in planning and ongoing maintenance• Monitor usage and results

BEFORE YOU BEGIN

• Review client profile / sensory diet

Communicate with staff re: mood, sensory interests and current health etc.

Sens

ory

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Sensory Diet is the multi-sensory experiences that one prefers to seek on a daily basis to satisfy one’s need for sensory produces self-regulation. A “SENSORY DIET” IS OUR ATTEMPT TO MODIFY STRESSORS AND CONTROL AROUSAL LEVELS AND IT IS UNIQUE TO EACH OF US.

The difference between a Sensory Diet and Personal Preferences:

A Sensory Diet is an unconscious processPersonal Preferences is a cognitive processCombined They Serve to Establish

Motivation

Sensory Diet

Ask questions of the person or family member

What is their favorite food, dessert, fruit etc.

What smells do they like. Look to places/vacations for hints. Did they enjoy the smell of the ocean or pine trees?

Remember some of the earliest memories maybe the most pleasurable.

Observation: Observe the individual in their environment. What seems to make the happy, what do they enjoy.

Use a questionnaire to determine the individual’s choice of preferred equipment motivator.

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Identifying Someone’s Sensory Diet

Identify the Sensation

Each element / piece of MSE equipment has multiple layers of sensory output that influences the individual’s sensory system.

For example: the bubble tubes offer, visual, auditory and tactile (particularly vibration) output.◦ The primary output is visual.◦ The secondary output could be the auditory “Hum”.◦ The third output could be the tactile vibratory sensation

How this input is approached or avoided by the individual is their sensory diet and personal preference.

For example: If they enjoy touching the bubble tube; putting their face and other body parts against the tube in all likelihood they are seeking the vibratory input.

Equipment Preference _________

Seeks/Enjoys: Avoids/Dislikes: Visual � � Visual � Light Touch � Light Touch � Deep Pressure Touch � Deep Pressure Touch � Movement � Movement � Vestibular / Rocking � Vestibular / Rocking � Constant Movement � Constant Movement � Being off the Floor � Being off the Floor � Being on the Floor � Being on the Floor � Smells � Smells � Sound Input � Sound Input � Sound Output � Sound Output � Vibration � Vibration � Sitting / Position Change � Sitting / Position Change Comments:

MSE can be one piece of equipment or a dedicated room. The decision to use which depends on the individual or population you are

serving and what outcomes or goals are being set and individual preferences

Presenting the MSE experience Requires

1.Present the multi-sensory equipment in the same consistent order and sequence of turning it on. Developing a individual protocol.

2. MSE Room must be a match with the individual’s sensory diet.

◦ Work with the body

◦ Goal: to establish feeling good about one’s self

◦ Utilize tactile & proprioceptive feedback activities within the MSE context

◦ As the individual experiences pleasure/fun, over time an emotional repertoire will result and the person is ready for generalizing relationship building with others, first in the MSE and then outside.

Developing the Individualized Protocol

Prioritize the order of turning the equipment on by what the individual likes most. (Match the Sensory Diet of the Individual with the equipment of choice).

For example if they approach a fiber optics and seem to enjoy the visual and tactile component turn this on first.

Then develop a sequencing for turning on the other pieces of equipment based on the interest, needs, and likes of the user.

What about MUSIC?

What about Aroma ?

Music The selection of music will depend on someone’s Life experience. Don’t used music with voice. If the individual can articulate what they like you should use this

type of music. If the type of music an individual likes is not prevalent some

baroque works well.

If they cannot express their choice, finding out what music works can be accomplished by:◦ Finding out what music they listened to as a child.◦ Finding out what music they listened to as a teenager and young adult.

Areas to investigate:◦ What music were the people around them listening to, when they had

no choice in the matter ? ◦ What radio station, TV program, video games were they exposed to?

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Aroma The use of aroma depends also on Life

Experiences

Remember the sense of smell is not inhibited and goes directly to the brain

Many people have allergies to smells

Finding a match for pleasure requires investigation

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Protocol for the MSE: Order of Initial Equipment

REMEMBER

1. Presentation the multi-sensory equipment in the same consistent order and sequence each session.

2. The MSE must be a match with the individual’s sensory diet for motivation.

3. No talking

PRIOR TO BEGINNING:

Prior to starting the MSE experience with someone have the regular room lights on and the dimmer spot light turned on all the way.

Bring the person into the room. Remember, at any time an individual’s wish to leave and terminate the experience must be honored and respected immediately.

Have the selected music playing

Example:Protocol for the MSE: Order of Initial Equipment

Start:

1. Have the selected music playing

2. Turn on the Bubble tubes. WAIT

3. After two minutes dim the regular room lights off. WAIT a two minutes.

4. Turn on another piece of equipment based on the individual preferces ( for example: maybe the a second bubble tube or the fiber optics)

5. Wait another two to three minutes and start turn the regular lights slowly off (by turning the dimmer down slowly); as you do this turn on the projector with a liquid six inch effects wheel. (start with the multi-colored wheel) WAIT, …. Do not rush the experience!.... WAITING for THEIR RESPONSE AND ACTION….IS KEY!

6. The next move or not, is up to the individual! This will all depend on the person’s sensory

interested, their arousal level, and the objectives of whether to increase or decrease arousal.

7. Using one DST switches (mega buttons or cube), demonstrate the function of turning the tube on and off a few times, or changing color. Put down the switch near the user and fade back out of sight. WAIT.

8. About fifteen into a session and you should start to observe a person begin to relax.

Example:Protocol for the MSE: Order of Initial Equipment

9. If the individual has remained in a comfortable position and appears relaxed, just let the gentle and unobtrusive atmosphere prevail. There is no need to rush things.

10. This maybe all that is required for equipment in the first session depending on the individual’s level of arousal or relaxation level. You may not achieve relaxation for a number of sessions until the environment is perceived as safe and it is considered predictable by the individual.

11. At about twenty five minutes into a session you want to reverse your order of turning equipment off slowly. The regular room lights should be the last to be turned on at the end of a thirty minute session.

Example:Protocol for the MSE: Order of Initial Equipment

WHEN IN MSE:VISION

Use light effects, fiber-optics, bubble tubes, Colorful toys, objects, parachute, Reflection, shadows, - Penlight play Winking, blinking, making faces Interactive switches

LISTENING

• Background music• Strong rhythms• Musical instruments, noisy

toys• Clapping, copying rhythms• Miscellaneous sound effects• Sound effects to accompany

effect wheels• Singing, humming, whistling • Making sounds • Interactive switches

COMMUNICATION

Facial expressions – joy, surprise, happy, bored, excited

Body gestures, touch, pantomime Eyes – smiling, crying, sleepy, awake, winking, blinking Eye-pointing for choice, selection Eye contact -communications Body posture – interested, agreeable, available Touch the device Vocalizations, making sounds

MOTION

• Rocking – therapy rocker

• Swinging - leaf chair • Bouncing• Rolling, sliding• Jumping• Changing positions • Moving with effect

wheels

EXPLORATION

Exploratory phase: (Week one) Following the equipment protocol that you have created for the individual allow the person to explore the environment and “relax”.

Depending on their response you may:

Demonstrate turning on the equipment with the switch. Do not verbalize what you are doing, or make requests of the individual. Just role model the behavior and move back.

If the individual speaks to you, and makes a request, honor it immediately. This has been positive engagement. Unless of course, they come over and hit you! Session Ends, slowly turn off all equipment.

If the session ended as described: The next day try again. When the equipment goes off, you intervene first and help the individual appropriately request the equipment be turned on. (Utilizing the appropriate skill level of the individual.).

You are beginning to develop a relationship with the person Next utilize the equipment and entire room to reinforce positive

behaviors and interactions.

EXPLORATION

AFTER THE MSE:

• Return the person to quiet location or • Restore MSE room equipment and

effects to original condition

• Clean/disinfect

• Record session

• Update users info card if necessary

• Communicate with staff

Once you have gained the trust and respect of the individual you are ready to apply any Best Practices to obtain targeted outcomes with the person.

Add complexity into the experience by using a control or DST technology to provide the user with an intermittent reward, making the situation a learning opportunity.

Have the equipment motivator set to go on as usual but, have it set (using the DST) to turn off after a predetermined length of time. (This will be the intermittent variable reinforcement)

When the equipment turns off, wait to see what happens do not rush to assist the individual.

This is the time to observe how they now deal with frustration, their ability to

problem solve, their own motivation level.

Engage the individual by put small but obtainable fun demands on the individual.

Advance protocol

How to pick the best piece of equipment for motivation? – Use switches

Attributes:

◦ produce cause & effect, plus factor

◦ produce the rewarding feedback within three and a half seconds

◦ It must be reliable

◦ operable by the intended person

◦ changes the duration: [The amount of time the item/toy will stay on before turning off itself, preset cycle]

◦ changes to Intensity - Frequency : [The item/toy has some element of change of speed, volume or light effect control.

◦ Do this at least for three to five sessions. (You may need more time to determine the motivator, if the individual is difficult to “relax” and the novelty effect is still operating.)

Types of Switches

Visual / Eye Gaze : usually high tech, control with eye control or gaze

Sound: making an noise or sound will cause an activation, microphones

Movement: switches which are placed on the individual and use some form of voluntary movement of the individual to activate the item/toy; example: Mercury switch.

Touch: This is probably the largest group of switches available; they use touch pressure movement to activate the item/toy

Switches are made to be very motivating

• Use sensory assessments

• Look for sensory opportunities in the bedroom, bathroom, dining room, day room, garden

• Make life a sensory cafeteria

• Enjoy the results alongside your clients!

THE ONGOING MSE

DIFFERENT POPULATIONS

USING THE MSE FOR DIFFERENT POPULATIONS

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IMPACT OF AUTISM

Odd responses to sensory stimuli

Oversensitivity to sounds

Oversensitivity to being touched

Exaggerated reactions to lights or odors

High threshold for pain

SENSORY EXPERIENCE

Possible goals for those with Autism

Improve social interaction and communication

Decrease the cycle of repetitive & stereotyped patterns of behavior

Decrease aggressive and other challenging behaviors

Decrease agitated behavior

LMessbauer,OTR 33

AUTISMRemember Multi-Sensory Environments

Increases: Social Skills Communication Skills Awareness and Interaction with the environment

Decreases: The need for self stimulatory behaviors Challenging Behaviors

IMPACT OF AGEING

• Social Breakdown• Declining Physical Health• Intervention• Decline• Institutionalization • Reaction of confusion,

apathy, aggression• Continued withdrawal• Dementia• Hopelessness

Break the loop of preservative speech

Decrease the cycle of wandering aimlessly

Decrease aggressive and other challenging behaviors

Decrease agitated behavior

SENSORY EXPERIENCE

Possible goals for those with Dementia

DEMENTIA Remember Multi-Sensory Environments

Maintains and/or Increases:◦ Communication skills◦ Control & empowerment ◦ Self esteem, personal identity, social confidence .

Decreases:◦ Isolation and withdrawal◦ Anxiety, stress and depression associated with loss

Our InspirationChristopher Douglas Fornes (1981-2006)

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For further information:

Sandra Fornesphone: 205-594-4875

fax: 954-252-2522e-mail: info@cdhaf.org

www.CDHAF.org

Christopher Douglas Hidden Angel Foundation (CDHAF) is a registered charitable organization in Canada and the USA.