Sensory Stimulation in Dementia Care

LWWJ283-02 April 19, 2007 0:24 Char Count= 0

Topics in Geriatric RehabilitationVol. 23, No. 2, pp. 102–113Copyright c© 2007 Wolters Kluwer Health | Lippincott Williams & Wilkins

Sensory Stimulation in Dementia CareWhy It Is Important and How toImplement It

Stephen Vozzella, BA, ACC

As persons with dementia regress, there is an increasing challenge to identify appropriate activ-ities. A therapeutic activity approach that can benefit persons with dementia is sensory stimu-lation. This article will review the meaning of sensory stimulation, for whom it is appropriate,and the benefits. The activity assessment is integral in determining activities that are successfulin stimulating the senses. The different ways to implement sensory stimulation are discussed.The writer refers to his own clinical experience of more than 10 years in the practical imple-mentation of sensory stimulation activities. The 6 different types of sensory stimulation andthe outcomes of sensory stimulation are described. Key words: activities, dementia, sensorystimulation

PLANNING and implementing sensorystimulation activities for residents with

dementia are imperative. As persons with de-mentia regress, the need for offering activi-ties increases. As the progression of demen-tia occurs, there are fewer opportunities forthem to initiate their own activities.1 Onething a caregiver can do to help the shrink-ing world is to offer sensory stimulation. Sen-sory stimulation can be used with persons inall stages: mild dementia, moderate dementia,or severe dementia. Sensory stimulation hasbeen shown to have a positive short-term ef-fect on their quality of life.2

There are many steps in implementing sen-sory stimulation correctly. The first step isto complete a comprehensive activity asses-ment; then you will know who is most appro-priate to receive sensory stimulation. Wheninstituting an activity, there needs to be a writ-ten plan of care detailing what type of activ-ity will be lead and how it will unfold. The

From the Copper Ridge and Fairhaven, Sykesville,Md.

Corresponding author: Stephen Vozzella, BA, ACC, Cop-per Ridge and Fairhaven, 710 Obrecht Rd, Sykesville,MD 21784 (e-mail: [email protected]).

cost and time needed for sensory stimulationneeds to be considered. Once all of these ar-eas have been delineated, one will be able tounderstand and successfully implement sen-sory stimulation for someone in need.

There are many documented benefits ofsensory stimulation: Relaxation, creativity,quality of life, decreased behavior problems,and decreased use of chemical restraints.3

Quality of life is increased through the personwith dementia being able to interact with an-other person in a meaningful way. The care-giver can provide this stimulation as they losethe ability to initiate personal interaction. De-creased behavior problems are found, as thereis a structured activity that focuses persons’ at-tention toward something they can positivelyinteract with. Involving the affected person inan activity plan has been found to have posi-tive effects on behavior and mood.4

Sensory stimulation is most appropriate forpersons with moderate to severe dementia,typically with a Mini-Mental State Examina-tion score of fewer than 10.3 At this pointin their progression, memory is significantlyimpaired, and persons present with difficultywalking, eating, and communicating eitherverbally or by written word.5 The ability toinitiate their own activities or even stimulate

102


SENSORY STIMULATION IN DEMENTIA CARE

their own senses is lost. For example, theycannot walk outside on their own to expe-rience the fresh air blowing in their face. Aperson may demonstrate a need for sensorystimulation by displaying behaviors such asrepetitive verbalizations, banging, clapping,rocking, or other self-stimulating behaviors.3

Sensory stimulation is conducted by stim-ulating 1 or all of the 6 senses. The 6senses are hearing, sight, touch, smell, kines-thetic, and taste.3 Assessing the person’sresponse can be a great challenge to the activ-ity leader because of the presence of expres-sive aphasia. The person with dementia maybe responding internally, but because of theirexpressive aphasia it cannot be measured.Aphasia is the inability to understand whatis being verbally communicated or the inabil-ity to communicate outwardly.6 The caregivermay never know if someone with dementia isresponding to what is being offered to himor her. The trained caregiver needs to un-derstand that interventions need to continueeven though there is not an obvious verbalresponse. Monitoring nonverbal communica-tion, such as facial expressions, body postur-ing, eye contact, decreased restlessness, orrepetitive behaviors, can be helpful.

ASSESSMENT

An activity plan cannot be successful with-out a thorough and ongoing activity assess-ment. First, an activity assessment is com-pleted, a plan is established, the plan isimplemented, and finally the response is doc-umented and evaluated. Then the cycle isstarted over. For example, a sensory stimula-tion activity is implemented for a person andno response is noted. Does this mean the ac-tivity leader or caregiver never attempts sen-sory stimulation with this person again? Ofcourse not! There are many different typesof sensory stimulation that can be attempted.The person’s inability to respond has to mo-tivate the caregiver to go back to the assess-ment and create a new plan and try again.A proper assessment should include informa-

tion about the personal history, medical back-ground, leisure pursuits, current abilities, andtheir current activity plan.

In long-term care the healthcare regulationguidelines refer to having an assessment forthe resident but they do not provide clearguidelines on exactly what should be in theassessment. There is room for the activityprofessional in long-term care to be creativewith the assessment to meet their needs forplanning.

The assessment for someone with demen-tia usually relies on several sources. The re-sources typically used are the person with de-mentia, a family member, a caregiver, a friend,or sometimes a miscellaneous source. It is im-portant to talk with the person with demen-tia to learn how they are currently function-ing. A family member or a close friend shouldbe interviewed for the personal history andleisure pursuits as the person with demen-tia usually will not be able to answer thesequestions accurately. It is usually best to in-terview the friend or the family member whohas known them the longest. If there is nofamily or friend to provide information, youcan look to other sources such as a clergy per-son or former coworker. A caregiver, if there isone, usually can provide an accurate look intothe person’s current abilities. The medical in-formation will come from reading doctors’/nurses’ notes and other disciplines such as so-cial work, physical therapy, occupational ther-apy, speech-language pathology, and dietary.The final section, the plan, needs to comefrom the activity professional once all the datacollection has been completed.

The personal history portion of the assess-ment should include information about howthey have evolved. Knowing the personal his-tory can help build individualized activitiesthat speak to the person’s past. If the per-son has some long-term memory recognition,this can be utilized in activity programming.The personal history should describe howold they are, marital status, education, placesthey lived in, types of job they held, and howmany languages they know. Language is veryimportant as the person knowing more than

VOL. 23, NO. 2/APRIL–JUNE 2007 103


VOZZELLA

1 language may be better able to understandtheir primary language. If they were in the mil-itary, include which branch they served in andtheir military action history. Do they have anyfamily members including siblings, grandchil-dren, great grandchildren, and friends whothey stay in touch with? It is also importantto learn how the family interacts with the per-son, and what they do when they are together.Another important question is whether or notfamily and friends need support in under-standing where the person is in the illness; dothey need education on how to make their in-teractions positive? As the person progresseswith dementia, family and friends strugglewith their decline. The activity professionalcan play an important role in helping the fam-ily or friend learn how to interact with theperson. The activity professional can demon-strate ways for the family or friend to engagethe person using activity props. The profes-sional can recommend what to bring for avisit, such as a box of old recipes or cleaningmaterials if the person likes to clean. The ac-tivity professional can also make activity sup-plies available to friends and family so they toocan use them when visiting. It is important toknow how persons typically spent their daybefore they had dementia. For example, dothey prefer early morning or to sleep in, dothey like to nap during the day, do they stayup late at night, did they stay indoors all daylong?

What was their personality like before theyhad dementia, what is it like now? What ma-jor events or milestones have occurred dur-ing their lifetime? Did they have major workaccomplishments, and have they traveled theworld, and have they lost a close family mem-ber? Defining milestones is important to un-derstanding the past and what is important tothem. Knowing the whole person is critical;the assessment that is built from this informa-tion will play a vital role in creating an individ-ualized plan.

Medical information is also a vital part ofthe activity assessment. Current diagnosis andhistorical medical information should be re-viewed. Knowledge of the person’s diagno-

sis will dictate how active they can be andwhether any precautions need to be put inplace during activity planning. Do personswear glasses, and do they have visual impair-ments that may affect activities? Hearing im-pairments should be identified; do they hearbetter in the left or right ear, and do theywear hearing aids? What is the hand they usedto write? What is their history of smokingand alcohol use? How is their ability to com-municate; do they have receptive or expres-sive aphasia or are they globally impaired?Do they communicate with nonverbal cues?The assessment should also include any assis-tance needed to perform activities of daily liv-ing. Knowing strengths and needs in this areawill help determine their ability to partici-pate. What type of assistance do persons needto ambulate? Are they independent? Do theyuse a walker? Do they need directions to findtheir destination? What type of diet is the per-son consuming? Do they have special dietaryneeds? Are they diabetic? Do they require spe-cial utensils? This section should also considerthe person’s history of likes and dislikes. Arethey allergic to any particular food? Do theyfind comfort in a particular food when they donot feel well? Is there a type of sweet they lookforward to? Finally, do they have any favoritefoods that they always enjoy? Food is such abig part of life that the activity professional isgoing to use food as part of the stimulationprograms, and the best foods to use would bethe person’s favorites. Food can be used in al-most all areas of sensory stimulation. Finally,in this section the activity professional shouldnote any testing or scales that have beencompleted to assist in tracking the person’sabilities.

Inquiring about leisure interests is very im-portant. The activity professional should sys-tematically ask about a comprehensive listof leisure interests and should make a notefor each category in regards to the statusof that interest. Do they still participate, dothey no longer care for this interest, do theyprefer this interest but do not participate init any more? There are many areas to delveinto from reading to shopping. What types of

104 TOPICS IN GERIATRIC REHABILITATION



books did the person read? Do they have a fa-vorite author? Did they subscribe to a partic-ular magazine? Do they still receive the sub-scription? Do they receive a newspaper? Havethey read the newspaper daily? If you knowfrom their personal history that they grew upin a different location, they might not be fa-miliar with the local paper. This is one areawhere technology can help the activity pro-fessional. Knowing the hometown or placewhere the person grew up, the caregiver canaccess some local headlines through the In-ternet. In some cases the newspaper can be

Table 1. Leisure interests—Activity assessment

Activity interest Questions to ask

Reading What do they like to read, do they have a favorite author, and do they prefer

newspapers to books?

Religion Do they go to church regularly?

Collecting Did they ever collect anything? Do they still have it?

Television Any favorite programs? Favorite news anchor?

Movies Do they have a favorite star? Do they like comedies, romance, or dramas?

Music Did they ever play an instrument, what types of music do they like to listen to?

Do they have a favorite entertainer?

Art/museums Do they like to go to art shows? Do they collect any?

Gardening Do they keep house plants? Do they grow vegetables? Do they prefer flowers to

vegetables?

Baking/cooking Do they have a favorite dish? What did they make for the children?

Sports What sports did they play? Do they follow a team? Do they have a favorite athlete?

Travel Places they have been, have they been to other countries? Have they a favorite or

seasonal vacation spot?

Volunteer Have they ever volunteered? Do they like to help others? This is very important if the

person lives in long-term care as the regulations do not permit residents to work in

the home, if it is documented they enjoy helping others, they have had a history of

volunteering, than it is appropriate they participate in work-like activities.

Clubs Are they still a member? Would the group want to participate in activity for this

person?

Children Do they enjoy being around kids?

Pets Have they ever had any pets? Do they like animals? Have they ever had a pet other

than a cat or a dog?

Reminisce Do they like to reminisce? What do they respond to? If you are interviewing a family

member, this is an opportunity to ask them. What do they reminisce with the

person about?

Social events Do they enjoy going to parties? This is important because their ability to socially

interact is declining and opportunities are usually less.1 What types of crowd do

they like to hang out with?

Humor What tickles their funny bone? Do they like comic strips? Do they have a favorite

comedian?

Games Do they like to play cards? Do they like checkers? Do they like to play bingo?

printed including the headlines with the mast-head. This may trigger memories for the per-son. Do they need large print or magnifyingglass or would they respond to talking books?These questions and similar questions shouldbe asked for every category. Table 1 providesa list of some of the areas the activity profes-sional should spend time recording interest inand some questions that might be used to gaininformation.

There are many questions to ask. The ac-tivity professional needs to budget their timeappropriately to do a thorough assessment.



VOZZELLA

It is important to note that although personscannot do everything they used to, the ac-tivity professional can adapt activities. Eachperson’s abilities will change with the pro-gression of the dementia, and the activityassessment will prove useful. With sensorystimulation, the activity professional continu-ally adapts the activity to provide the maximalbenefit.

The next part of the process is assessingthe person’s ability to participate in activities.This is completed by assessing how the res-ident participates in activities of daily living,interviewing the resident, talking with othercaregivers, and observing the person duringactivities. Observing the person during largegroup activities may be difficult as the per-son may not be able to focus on the activ-ity in this setting. The activity professionalshould bring some activities with them whenthey meet with the person. They might bringa balloon for a game of volley, pictures forreminiscing, or a popular magazine. This isone area where the activity professional canbe creative with how they want to involvethe resident and they may have even devel-oped an assessment routine utilizing differentprops. Once an evaluation has been finishedon how the person participates, there are sev-eral items that should be part of the review.How do they participate? Are they able to ini-tiate their own activities? Can they participatein activities with cuing? Do they participate inactivities passively or actively, or do they at-tend an activity and appear unaware that theactivity is occurring. The person may be at acouple of different activity levels, such as theycan initiate certain activities but need assis-tance to participate in others. The assessmentshould also note how much help they needto participate. These variables would includeminimum, moderate, or maximum assistance.The person should also be assigned an over-all activity level of high functioning, moder-ate functioning, or low functioning. Identify-ing this level will help in the planning processwhen the activity professional needs to adaptactivities, and it can also help the activity pro-fessional if they are working in an institutional

or a group home situation and they are dealingwith numerous clients.

Once the assessment is complete, the activ-ity professional will formulate a plan of care.What are the person’s current strengths andweaknesses? The goals should reflect the in-dividual, his or her ability to participate, andhis or her strengths and weaknesses. The planshould also reveal what approaches will benecessary for the goal to be obtained. All care-givers who interact with the person shouldread the activity assessment to increase his orher working knowledge of the person. Thisshould increase the opportunity for betteractivities.4

LEADING A SENSORY STIMULATION

ACTIVITY

There are 5 different settings in whichan activity can occur. These settings includegroup, individual, drop-off, spontaneous, andenvironmental activities. In a group program,the goal is to involve several people in asensory-themed activity. Individually, the per-son can be engaged by one activity profes-sional. The activity could be spontaneous,meaning that it is not planned. The activitycould be a drop-off program in which the care-giver has taken an activity to the person andgives it to him or her to engage in. Sometimesthe person will need the activity leader to helphim or her get started, and then the personcan engage in the drop-off activity on his orher own. Lastly, there are environmental activ-ities that stimulate. Examples would includefish tanks, bird aviaries, paintings, etc.

Leading an activity involves significantpreparation; before the activity is led, thereneeds to be a plan. The activity should reflectinterests and abilities; if it is a group activ-ity, then the whole group’s interests need tobe taken into account, and this is where theactivity assessment plays an important role.The activity should be adapted to current abil-ities. If the leader is running a group program,this may require different approaches for eachperson in the group. The person needs to be




given the best chance to be successful. A strat-egy to assist with this is to break the activityinto steps. The activity leader should also havea backup plan when he or she is leading anactivity, so if the person or persons are notparticipating, the leader can make note of it,and if time permits, attempt another type ofactivity. A quiet environment provides an in-creased opportunity for the person with de-mentia to be able to focus on the activity. TVs,radios, and other environmental noise distrac-tions need to be turned off while an activityis occurring. For individual activities, use ofthe person’s room may be ideal to minimizedistractions. They may feel very comfortablein this room, therefore enhancing their abil-ity to relax and participate. Lighting needs tobe considered on the basis of the person’s vi-sion and preferences; some prefer brightnessand some prefer a darker room. The activityleader may also want to consider leading theactivity outside. Doing an activity outside canenhance alertness and thereby increase par-ticipation. However, careful note needs to betaken on whether or not they have a positiveresponse to an outdoor activity or if they ap-pear distracted by being outside.

The leader may also want to consider bring-ing music into the program as music usuallybrings about a positive response. Music mayalso assist in keeping the participants’ interestfor a group activity if the leader is gathering agroup. Spirituality may also want to be takeninto consideration as their religious affiliationmay be very strong, which may enhance theirresponse to the activity. Props are usually es-sential to the activity as they can help to gener-ate responses. To make the activity more suc-cessful, the leader should have all the propsready before they start. An activity needs toget started promptly without the participantshaving to wait. For group programs, the leadermay lose participants’ attention quickly with-out careful preparation and planning. Theleader should always be patient with the par-ticipants as they are going to need time torespond to the activity and may be morelikely to participate if they are given timeto respond whether it be verbally or physi-

cally. The leader needs to be aware of howthey are communicating. Again this is wherethe assessment is helpful, it should identifyhow persons communicate and what impair-ments they have. The leader may need touse nonverbal cues, and he or she may needto stand or sit on a certain side of the personto enhance the communication. The activityleader should be aware of what their facial ex-pressions and body language are as they mayrespond to these messages and may be morelikely to respond to the nonverbal messagesdue to their aphasia. The leader needs to beaware of the participation level so he or shecan make notes after the activity. The leadershould be focused on how the person is par-ticipating in the process not necessarily thefinal outcome. For example, if the person ispainting, then the result of how beautiful ornice the picture is does not matter, what mat-ters is how the person is painting and how heor she is involved in painting.

The activity leader may use cues or ques-tions to garner a response. Examples mightinclude the following questions: What doyou see in the picture? What does the smellmake you think of? Have you ever been tothe opera? What does this sound or noisemake you think of? Does it remind you ofanything? What does this picture make youthink of? What is your favorite way to eatthis food? Have you ever cooked this food be-fore? Does this surface feel smooth or rough?Is the object too heavy for you to lift? Theactivity leader may not always need to cuepersons with questions, as they may notrespond to verbal questions; some personswill respond better if there are nonverbalopportunities.

THE 6 TYPES OF SENSORY STIMULATION

Auditory stimulation

Auditory stimulation is being able to stim-ulate using sound. There are many ways togain a response using the auditory sense. Arecording of favorite song can be played; ahammer can be banged against some wood



VOZZELLA

or nails. Sounds may trigger a memory ora reaction from the past. The person withhearing loss will likely have decreased abilityto clearly hear the sound. Depending on theseverity of the person’s dementia, his or herability to understand the sounds may also beaffected. If the person is having difficulty hear-ing, the activity leader may want to make thesounds closer to the person and repeat thesound. They may also try an amplifier withheadphones. If the person is having difficultyinterpreting the sound, the activity leader maywant to try repeating the sound, or they maywant to include other sensory cues with thesounds. The assessment of the resident willprovide important clues into his or her historythat will help determine what sounds theyare more likely to respond to. Listed are ex-amples of auditory stimulation activities: lis-tening to familiar sound effects and then dis-cussing them, for example, listening to thesound of a bugle played at a horse track sig-nifying the start of the race, the clanging ofcoins to demonstrate the noise of betting, thesound of a crowd cheering to create the feel ofthe horses coming down the home stretch, lis-tening to music and dancing to it or playing aninstrument with it, making music with instru-ments, tools, or a noisemaker, reading storiesthat relate to the person’s background. A spiri-tual sensory could be conducted utilizing spir-itual hymns, the hymns could be sung, read,or listened to, prayers could be read or therecording of a service could be played. Thereare many creative ways to stimulate the audi-tory sense.

Visual stimulation

Visual stimulation involves drawing a re-sponse from looking at pictures, objects,scenery, etc. Persons are likely to respond toitems they are familiar with, again making theassessment such a key part of building the ac-tivity. As persons’ dementia progresses, theirability to understand what they are looking atmay be challenged. This is the symptom of vi-sual agnosia. Some visual cues they have re-sponded to may not be as effective. It is also

possible that their vision may be one of theirstronger senses so they may respond more tovisual stimulation than to other senses. Thisdescription highlights the fact that each per-son is affected differently and is need of an in-dividualized plan to treat their illness. Listedare some examples of visual stimulation ac-tivities: looking a photo from a family album,collected photos that might be hanging ina bedroom, familiar objects that the personmay have collected over the years such asa trophy, statue collection, paintings, or hats(these items will really help to speak to theindividuals history); going outside to look atplants, clouds, cars, flowers, or trees; andwatching videos (the videos could be person-alized by family and friends) (activity leaderneeds to pay attention to how well the per-son focuses on TV; some people with de-mentia have a difficult time staying focusedon television). Animals, such as birds, rabbits,fish tanks, cats, and dogs, and magazines andchildren could be utilized. Intergenerationalprograms can be very stimulating, seeingchildren in Halloween costumes, playing, orreading. Reviewing pictures of buildings orplaces from the person’s hometown can cre-ate a lot of interaction. In one case, a personwas shown pictures of the building he workedat for 12 years, he immediately started tellinga work story and talking about how happy hewas to work there.

Olfactory stimulation

There is certainly a great connection tosmells and memories, and olfactory stimula-tion can cause sensory-deprived people to be-come alert.7 How many times are connectionsmade when a person smells something and in-stantly had his or her memory triggered to ex-actly to a poignant moment when he or shesmelled this scent in the past? Using differenttechniques such as smelling spices, discussingmemories associated with certain smells, tak-ing flower petals, and giving them to theperson to smell, there are scratch and sniff re-sources that can be used for this activity thatcan contain smells from oranges to gasoline,




there are markers that are loaded with particu-lar scents, there are machines that can be pur-chased that offer different odors, there are es-sential oils that can be utilized (essential oilsshould be used very carefully and the benefitsof the essential oil should be clearly noted aseach oil has a different purpose and the activ-ity leader should be sure of using them safely;some essential oils can be overstimulating orinduce ill feelings), using food extracts suchas vanilla, mint, or lemon may help the personrecall memories or stimulate thoughts. An aro-matherapist can be hired to specialize in stim-ulation of the sense of smell. Considerationhas to be given to how impaired their abilityto identify smells, and do they recall or havememory of those scents?

Painting with food can create a stimulat-ing environment. A piece of paper with apicture of a coffee cup can become a smell-stimulating art project. The person would firstpaint the picture of the coffee cup with glue.Then he or she would take the coffee groundsand rub them into the glue so they formthe shape of the coffee mug. Allowing thegrounds and glue to dry would give time forthe activity leader and the person to talk aboutwhat coffee means to them. Once the pictureof coffee grounds is dry, the person has a pic-ture he or she can smell and enjoy. This activ-ity could also be done with spices, jell-o, orchocolate powder.

Tactile stimulation

Tactile stimulation is performed by hav-ing persons with dementia touch items thatcreate a positive response. They can touchsurfaces and objects with varying textures,plants, and water; the possibilities of what youcan introduce are endless. Determining whattype of tactile stimulation brings about a pos-itive response can be a challenge. Do they en-joy putting their feet in sand? Do they like totouch clay or potting soil with plants? Do theyenjoy rubbing a feather against their cheeks?Do they respond to touching different fabricsand yarns? Are there familiar items they liketo touch or feel that trigger long-term memo-

ries? It is also important to document the re-sults of what has been tried with the personas you want to be able to look back and seewhat has worked and what has not. As the per-son is touching the activity prop, you can askhim or her questions such as the following:Is the surface smooth or rough? Is the objectheavy to you? Do you like the color? Is it hotor cold? The activity leader should observewhether the person feels comforted by theobject. Another technique that can be utilizedis rubbing the prop against the person’s handor arm with an appropriate verbal cue. Cau-tion should be used with touching to avoidany touch that could be misinterpreted.3 Itis important to be aware that some personswith dementia may have been victims of el-der abuse. They may have very negative re-sponses to tactile stimulation; thus, the activ-ity leader needs to be gentle and very aware ofhow the person is receiving the touch stimu-lation. Some example activities would be asfollows: looking through and touching wall-paper swatches, these books can usually beacquired for no charge as wall paper compa-nies may throw them out when a line getsdiscontinued, stuffed animals—this might besomething they keep with them all the timeand it can reflect their personal preferenceof animals, pillows could be used to holdor to touch as the pillow may have differ-ent textures on them, yarn can be rolled orfelt—it can be stimulating to touch and itcould speak to a past interest if the personcrocheted, sand paper to touch or to rubagainst a block of wood—this activity mayalso speak to the person’s past interest and isinexpensive to keep around. Massages can bedone on the hands with hand creme. Wash-ing hubcaps, waxing a car hood, cleaning thefloor mats of a car, peeling vegetables, foldingclothes, touching clothes with different tex-tures and fabrics, snapping beans—all of thesegive the person a chance to be successful witha task, dusting—the cloth is stimulating rub-bing hands on furniture, or counter can alsobe stimulating, sorting bills or check stubsjust touching the bill paper or check papermay be stimulating, cleaning or wiping down



VOZZELLA

tables or furniture, polishing silverware—thisactivity would have been done with a non-toxic cleaning material (if this is not avail-able, a wet cloth would be a good substi-tute), bubbles can be blown for the personto pop or touch—this could be done with achildren group to tie in the intergenerationalaspect that can potentially increase the per-son’s ability to focus and participate. One pro-gram that has been successful is using snowto touch. Snow can used to shape snowballsor snowman. This activity can be done insideor outside. Snow for some is something thatthey will recall from younger days, and play-ing with it may also rekindle fond memories.One activity that can be done with snow isto take a Styrofoam ball and rub some snowaround it; as the snow melts, it will adhere tothe ball. The cold feel of the snow may also bestimulating. After the person is finished withthe snow, he or she can be given some warmhot chocolate. Touching the warm mug canbe stimulating and bring back memories. Thehot chocolate is pretty consistent with beingin the snow as it might be something the per-son drank years ago after shoveling snow ormade for their children after playing in thesnow. One challenge with this program is thepotential lack of snow. Snow can be made us-ing a fine ice chipper that is usually used formaking snow-cones. There are some compa-nies that market snow-like products that arenontoxic. There are many programs that cancreate an opportunity for touch stimulation,using assessment and some trial and error, theactivity leader is bound to find the right one.

Taste stimulation

This is one area where mealtime can bean interactive time for the caregiver, for ex-ample, talking about the textures of the foodthey are eating. Reminiscing about differentways to prepare foods can be stimulating dur-ing a meal. Example questions include the fol-lowing: Do you like your vegetables soft ortough? Do you like to boil your potatoes orbake them? Do you like your soup steaminghot or do you like it warm? Do you like sugar

on your oatmeal? Do you like your chickenfried or baked? Some of the questions that canbe asked to stimulate discussion and memo-ries are as follows: Does that food taste spicyto you? Does it taste sweet? Do you like sugarin your coffee? Do you like marshmallowsin your hot chocolate? Do you like garlic inyour pasta sauce? Reminiscing about going tothe market or growing the types of foods canbe beneficial. Example questions would be asfollows: Did you grow your own fruits andvegetables? Did you go to the grocery storefor your vegetables or did you go to a farmstand? Did you have your eggs delivered? Didyou have an icebox or did you store yourmeat in a springhouse? Did you use couponswhen shopping for foods? Using these ques-tions during mealtime may increase the inter-action between the caregiver and the personaffected. Mealtime for many persons with de-mentia can be a time of enjoyment and suc-cess with familiar and functional tasks thatstimulate the senses. The activity assessmentand dieticians’ notes can be used to identifyfavorite foods and also foods to avoid. Therehas to be great consideration for diet restric-tions, thickened liquids, or altered food con-sistencies. If the food is pureed, it can reallybe helpful to reminisce about the foods ordiscuss in a manner to help cue persons towhat they are eating as visually the food maynot be recognizable. Some example activityideas to stimulate the sense of taste would betasting spices, tasting drops of extracts, tast-ing drinks with lots of flavor such as cocoa,alcohol-free beer or wine, and orange juice,reminiscing about foods, looking at picture ofdifferent meals, cooking or baking togetherand then tasting the foods made, and havingchocolate chips and a party with a particu-lar theme of food such as a chicken day withchicken nuggets and assorted spices and dip-ping sauces. A pudding program will combinemany of the different types of sensory stim-ulation but will end with the person beingable to eat the pudding; it also does not re-quire many steps so a person who is low func-tioning should be able to participate. If per-sons are able to mix the pudding, they get the




opportunity for kinesthetic stimulation, andthey can smell the pudding powder before itis mixed with the milk. Instant pudding is rec-ommended with only 5 minutes to wait forthe tasting after the pudding is prepared. Apotato chip sensory activity can be used witha variety of flavors of chips. To add to thepotato chip sensory experience, the programcan include the history of how the potato chipwas invented. The chips can be washed downwith some alcohol-free beer or soda pop.

Kinesthetic stimulation

Kinesthetic stimulation is performedthrough active movement, which has manybenefits. This is important because of thedecreased physical activity and mobility withdementia. This results in decreased appetite,mood, and oxygen intake, which may impactcognitive functioning.3 There are many dif-ferent ways to involve the kinesthetic sense.The movements should be simple and involvesomething that is familiar to the person. Thismay increase the person’s ability and interestin participating in these movements. Exerciseis not always seen as fun, so if it can bemade into fun or familiar movements, theremay be greater participation. It is importantto monitor persons’ ease in participatingin the movements. If they are grimacing orverbally complaining, then the movementsneed to be either ended or limited to justa couple of repetitions. Knowing persons’medical history will help identify whetherthere are areas of concern when it comesto movement. If the person has a history ofaggressive behavior, any activity prop theperson uses has to be monitored closely toavoid injury to themselves or others.

Some of the activities that can be usedand that will highlight the kinesthetic senseare playing musical instruments such as jin-gle bells, maracas, drums, or egg shakers, andthrowing activities with footballs, baseballs,beanbags, horseshoes; you could add somezing to the activity by having the person tosswater balloons. Hitting a balloon back andforth is a great activity because the person can

hit the balloon with feet, legs, knees, hands,elbows, and head. Painting is a good kines-thetic activity as persons can create some-thing as they move, they can paint a small pic-ture, or for larger movements they can paint amural or paint a wall. Another activity is walk-ing and the walking can be creative; personscan push a baby stroller, a shopping cart, anda lawn mower (with a disabled engine). An-other way to stimulate the kinesthetic sense isto sit in a rocker or to sit on a swing; there areproducts on the market that will enable per-sons to swing and to make it easier for them.Petting animals, such as petting a horse or rab-bits or, of course, a dog or cat, will help stimu-late the kinesthetic sense. Another way to in-clude housework in the kinesthetic sense canbe folding napkins, stuffing envelopes, wash-ing a counter, sweeping the floor, rolling somedough, or vacuuming. There are many ways tostimulate the kinesthetic sense, and the activ-ity professional can find activities that are funbut also allow the person to enjoy and cele-brate the ability to move.

COMBINE ALL THE SENSES

Now that the 6 different areas of sensorystimulation have been reviewed, they need tobe put together to make a whole program.This gives the activity leader a way to stim-ulate all 6 senses in one activity. One activ-ity that demonstrates this is a spring sensory.Start the activity by looking at a picture ofa field of daffodils blooming, as the personis looking at the pictures, a cd being thathas sounds of birds’ chirping can be played,then the person can smell some fresh onion,sip some iced tea, touch some green grassclippings, and finish the activity by throwinga baseball to the activity leader who is using amitt to catch. This type of planning should bedone throughout the year. Each week shouldhave a theme assigned to it. This will help theactivity leader in the planning process. A pro-gram that highlights the theme can be createdeach week, and it can speak to each of the 6senses. This will keep the person stimulatedat the highest possible level.



VOZZELLA

OUTCOME MEASURES

Evaluating the activity is part of the pro-cess. The activity leader needs to make noteof how they participated, what were they do-ing during the activity. Were there any mo-ments that really stood out during the pro-gram? Did they shout a funny word or whis-tle a part of a song? Did they cry? Did theylaugh? Did they frown? Did they clap? Didthey reach out for the activity prop? Did theyverbalize but were not able to be understood?There are lots of different expressions that canbe noted. The activity leader should also notehow much cueing was needed for the personto participate in the activity. Did they needminimum, moderate, or maximum amountsof cueing to participate? Documentation ofthe program can be vital as a way to describeto family members how they are progress-ing in activity interventions. The documenta-tion is very crucial in validating whether goalsfor the person are being met. Documentationcan also speak to how an overall activity pro-gram is succeeding if the program is gearedfor a group population. Documentation isalso required to comply with state healthcareregulations.

There are many factors to look at when es-timating the cost of an activity program. Thenumber of persons who require sensory stim-ulation must first be determined. Then the ac-tivity professional would determine how theywould participate in group, individual, drop-off, or environmental activities. Then the ac-tivity professional would have to determinehow much time is needed to meet these pro-grams. Once the types of programs and theamount of time needed to meet them havebeen determined, the cost for supplies, props,and staff can be estimated. An activity coordi-nator is going to have a larger salary than anactivity assistant and will increase the cost ofthis programming. Any staff could potentiallybe trained to lead the sensory stimulation ac-tivities. The key would be to make sure thetraining covered the important points of lead-ing these programs. Training time would needto be factored into the overall costs for sen-

sory stimulation. The use of volunteers to leadthe activities could potentially save the orga-nization money in this, although you need toaccount for training time and the need for abackup plan if the volunteer is not present forthe programs. Interested family members canbe trained in providing sensory stimulationduring one-on-one visits, and are often will-ing to bring supplies and props from home.There are a lot of products on the market forsensory stimulation. Props are definitely nec-essary for a sensory stimulation program tobe successful. Budgeting for purchase of thesesupplies could really bolster the life of the resi-dents. Budgeting for the program also demon-strates an organization’s commitment to pro-viding a necessary program to meet the needsof a segment of the population. The activityprofessional may also look to alternatives forpurchasing supplies. The Internet could be aresource for pictures, stories, poems, sounds,etc. The public library could also be a re-source for props, and the only cost would bestaff time to retrieve the items from the librarysystem. As a lot of props for sensory stimu-lation might be from a long time ago, propsmight be secured from a second-hand storeor from a relative’s attic. Donations could po-tentially cut into the cost in this area; it maybe helpful to have a wish list set up for po-tential donors who are looking to help theorganization.

CONCLUSION

Sensory stimulation has many facets. It canbe used in a structured setting. It can be usedspontaneously. It can be used during care sit-uations. The fact that it can be used in somany areas makes it a powerful tool, one thatfits perfectly into the caregiver’s tool belt. Itis the caregiver’s responsibility to make sen-sory stimulation available. The key to suc-cess is that the caregiver has a good activ-ity assessment, follows steps to lead activities,budgets time and financial resources, docu-ments success and failures, and is aware ofthe different ways to stimulate a person using




the 6 senses. Appropriately and adequatelyperformed, this well-rounded approach will

turn the sensory-deprived person’s life into anengaged one.

REFERENCES

1. Spaull D, Leach C, Frampton I. An evaluation of the

effects of sensory stimulation with people who have

dementia. Behav Cogn Psychother. 1998;26:77–86.

2. Wareing L-A, Baker R, Bell S, et al. Both multi sensory

stimulation and activity sessions improved mood and

behavior in dementia in the short term—A random-

ized controlled trial of the effects of multi sensory

stimulation for people with dementia. Br J Clin Psy-chol. 2001;40:81–96.

3. Bowlby C. Therapeutic Activities With Persons Dis-abled by Alzheimer’s Disease and Related Disorder.

Gaithersburg, Md: Aspen Publishers; 1993.

4. Cohen-Mansfield J. Non-pharmacologic intervention

for inappropriate behaviors in dementia. Am J Geri-atr Psychiat. 2001;9:361–381.

5. Rabins P, Lyketsos C, Steele C. Practical DementiaCare. New York, Oxford: Oxford University Press;

1999.

6. ASHA. Aphasia. Available at: http://www.asha.org/

public/speech/disorders/Aphasia info.htm. Accessed

April 10, 2007.

7. International Journal of Leaders in end of life care.

Innovations in the end of life care an interview

with Scott Trudeau MA, OTR/L. Available at: www2.

edu.org/lastacts/archives/archivesjune99/featureinnl.

asp. Accessed January 15, 2006.


Date post:	26-Oct-2014
Category:	Documents
Upload:	nikki-swift
View:	33 times
Download:	0 times

Sensory Stimulation in Dementia Care

Documents