multi-sensory environments: combining the benefits of snoezelen, stimulus preference and human...
TRANSCRIPT
Multi-Sensory Environments: Combining the Benefits of Snoezelen, Stimulus
Preference and Human Systems Dynamics
Janice K. Ryan, OTD, OTR/L
Certified Human Systems Dynamics Professional
Owner: Human Systems Occupational Therapy
Board Member: AAMSE
Chattanooga, TN
Presented for: American Occupational Therapy Association Annual Conference & Expo, April 18, 2015, Nashville, TN
Linda Messbauer, MOT, OTR/L
Owner: Sense-zational Environments, LLC
Founding Member AAMSE, Member Board ISNA, Snoezelen, Designer First Snoezelen Room in USA
Fresh Meadows, NY
www.lmessbauer.com
Objective Number Today’s Objectives
1 At the conclusion of this session, participants will be able to analyze five differences between Snoezelen, Stimulus Preference and Human Systems Dynamics Environments.
2 At the conclusion of this session, participants will be able to explain how the Adaptive Response Model can be used to learn to facilitate multi-scaled adaptive responses.
3 At the conclusion of this session, participants will be able to apply knowledge to verbalize how to facilitate perceptual, affective and social adaptive responses within an MSE.
Where did Multi-Sensory Environment’s originate?
• Founded in Netherlands and in use in 34 countries known as Snoezelen
• First US Snoezelen room was designed by Linda Messbauer and installed by Lifespire, Inc. in 1992.
• Most common use was originally with autistic and severely developmentally delayed clients.
Used with Permission. Photo taken by: Linda Messbauer, OTR/L., Sen-sational
Environments.
When were MSE’s developed in the United States as a therapeutic environment?
• Utilized in treatment by Linda Messbauer for over 30 years by coupling the Snoezelen with the Sensory Personal Preference Environment concept.
• The American Association of Multi-Sensory Environments was developed in 2006.
• The Human Systems Dynamics approach was added to the therapeutic environment in 2008. The first AAMSE trainer was certified specifically for dementia this year.
Used with Permission. Photo taken by: Linda Messbauer, OTR/L., Sen-sational
Environments.
Snoezelen, Stimulus Preference and Human Systems Dynamics Environments
The Occupational Pattern Forming System and…
Multi-Sensory Environments: Similarities & Differences
Multi-Sensory Environments
• Standardized Room Design, color and Equipment for Treatment based on Population served
• Environmental Demands• Choice Driven Voluntary• Empowering• Shared Control by Pactitioner and
Client• Used to change Arousal levels, first
Snoezelen
• No standardization of Room Design, color or Equipment
• Demand Free• Choice Driven Voluntary• Empowering• Exploratory• Client Controlled • Used primarily for
Relaxation
The Human Systems Dynamics of Multi-Sensory Environments
• Begins as a Client-Environment Container with the Practitioner on the outside controlling the exchanges
• When the therapeutic relationship shifts the Client has paired the Practitioner with the Environment
• The shared pleasure experience supports a sense of Trust and Safety
• After the Client becomes attached with the practitioner there is a shared sense of empathy that enhances the number of exchanges
• Increased successful exchanges increases learning potential
Using a Multi-Sensory Environment to Facilitate Neuroplasticity
• Multi-Sensory Environments can be used to facilitate implicit memories through the use of physical, personal, spiritual or cultural cues.
• When a client is fixated on an object or limited part of their environment, personal preferences and subtle meaning cues are used to enter the client’s constrained or foreground attentional container in order it to expand and deepen it.
• When a client has trouble focusing their attention, these same cues can be used to tighten their unbounded attentional container in order to constrain it and bring it forward.
• Allen Cognitive Level 1 and 2 clients can benefit from treatment in a Multi-Sensory Environment and have been known to regain previously lost skill levels.
The Stimulus Preference and Human Systems Dynamics Environment
Optimizing MSE Treatment
Play Therapy for People with Dementia:
GROUNDED THEORY 1:
Meaning making behavior may be thought of as the unconscious search for flow throughout the infinite game of a lifespan and the finite game of the moment.
Meaning making on a PEO Landscape is the Model that aids a practitioner in support of a client adapt through occupational exchanges to help them find their current adaptive capacity. Adapted from the HSD Landscape Diagram (Human Systems Dynamics Institute, n.d.)
Created by Janice Ryan (Ryan, 2013)
Model Created by Janice Ryan (Ryan, 2013), Illustrated by Breanna Wright, Rx TN Center for Teaching Arts and Technology, Roane State Community College Adapted from the HSD CDE Model (Human Systems Dynamics Institute, n.d.)
How do combine multi-sensory, human systems dynamicsand personal preference environments during treatment?
Adapted from the HSD Radical Inquiry Model (Human Systems Dynamics Institute, n.d.); Created by Janice Ryan (Ryan, 2013)
The Emotional Self-Regulation Checklist (Ryan, 2013)
facilitate perceptual, affective and social adaptive responses within an MSE
The Seed of Transformative Change in MSE Thinking…
A Conceptual Framework: Neuroplasticity: Experiential learning through iterative adaptive responses over time…
• Implicit v. explicit memory• Working memory• Volitional control over attention and learning• Hippocampus responsible for long-term memory• Intentionality-Meaning-Perception process
(Kristin G. Bell, Carolyn K. Daniel, Ben A. Hoagland, Haley D. Pukenas, & Janice K. Ryan, 2011)
Therapeutic adaptive responses are:Just what the client needs… just when they need it…
Adapted from the HSD Adaptive Action Model (Human Systems Dynamics Institute, n.d.); Created by Janice Ryan (Ryan, 2013)
We do this by considering the client’s meanings.
(Created by Janice Ryan, 2013; Adapted from Human Systems Dynamics Institute)http://wiki.hsdinstitute.org
What are multi-scale adaptive responses? The seed of neuroplasticity for a client AND a mindful therapist…
• Perceptions include development of new
patterns of self & social awareness within an ever changing multi-sensory environment
• Meanings are on the transformative scale at which neurochemical changes in the brain allow for new awareness and lifelong learning to occur
• Intentions are the neurochemical
shifts that allow for a new meaning to replace a previously habituated or sensitized response.
(Lazzarini, 2004)
A Mindful Therapist attends to multi-scale adaptive responses beginning with their relationship with the client…
Observe:a consciousness discipline that
begins with self-awareness
Understand:A state of
“moment-to-moment
awareness”
Influence:An attitude of
focused intentionality
(Schmidt, 2004)The Microscopic Scale
A Mindful Therapist is aware of the transformative potential of the multi-sensory environment…
Observe:Two way exchanges between client and
environmental cues.
Understand:How a client’s
responses inform on the state of their nervous
system for learning.
Influence:Facilitate
experiential or developmental
learning.
(Schmidt, 2004)The Mesoscopic Scale
A Mindful Therapist facilitates engagement in the occupational context.
Observe:The mindful
therapist learns to focus attention on
the client’s meaning making process.
Understand:The mindful
therapist learns to understand what a
client’s adaptive action and response
patterns mean.
Influence:The mindful
therapist is called upon in practice to
generate new action plans to meet each
client shift.
(Siegel, 2010; Wittrock, 1992)The Macroscopic Scale
Treatment of PTSD & Dementia by Reducing the Stress Response
Reduction of the stress
response
Positive response to
mindful clinical interactions
Expresses comfort due to
familiar, positive cues from prior
positive relationships
• Creating Human Systems Dynamics and Personal Preference Environments within the MSE Container are a key to these improvements.
(Kristin G. Bell, Carolyn K. Daniel, Ben A. Hoagland, Haley D. Pukenas, & Janice K. Ryan, 2011)
Treatment of PTSD & Dementia by Improving Relationship to Self
Relationship to self
Relates to past life experience
Relates to general life
Recognizes personal growth
Recognizes learning
process takes time
Recognizes limits in
understanding
• Both PTSD and Dementia negatively influence a person’s thoughts-cognition-behavior by detaching them from TODAY’s reality and their own sense of self.
• Today’s decisions are commonly based on yesterday’s reality.
• Treatment within an MSE can support unlearning of old realities that are interfering with today’s life/occupational patterns.
(Kristin G. Bell, Carolyn K. Daniel, Ben A. Hoagland, Haley D. Pukenas, & Janice K. Ryan, 2011)
Leading to an emerging community partnershipOur Co-Evolutionary History
Visual Orientation (noticing)
Orient to close range visual field (12 inches from eyes) Orient to mid-range visual field (between 12-inches and mid-range in room) Orient to full-range visual field (between mid- to full-range of room)
Visual Scanning (sustained attention/more focused) *10 seconds
Scanning within close range visual field (12 inches from eyes) Scanning within mid-range visual field (between 12-inches and mid-range in room) Scanning within full-range visual field (between mid- to full-range of room)
Visual Tracking (following) *10 seconds
Following within close range (following hand movement w/ eyes on object within reach) Following within mid-range (follow movement of person in front and/or beside self within 6 ft) Following full range (follow movement of person within entire room)
Auditory Localization (noticing)
Localize to sound input within close range (noticing source of radio music source within 12 inches of self)
Localize to sound input within mid-range (noticing direction of radio music at 6 ft) Localize to sound input within full-range (head turning to sound in full room)
Auditory Attention (sustained)
Attention to obvious sounds (loud sound pattern 10 secs) Attention to background music (10 secs) Attention to multi-system (attending to activity with background music 10 secs)
Auditory Sensory Motor (interacting)
Rhythmic patterns of movement such as dancing, rocking, clapping, snapping or tapping fingers Interacting with music through voice such as humming, whispering, singing or talking about the
song Interacting with music through sharing of memorized lyrics--singing
Emotion---awareness (mirrored)
Enhanced Facial Presence (eye contact) Enhanced Body Presence (shaking hands) Enhanced Behavioral Presence (reaching out for a hug)
Research began with phenomenological analysis of videotapes.
(Becca Jones, Chris Edwards, Krista Robinson, & Josh Fogleman & Janice K. Ryan, 2011)
1 2 3 4 5 6 7 8 9 10a) close rangeb) mid rangec) full rangea) close rangeb) mid rangec) full rangea) close rangeb) mid rangec) full range
1 2 3 4 5 6 7 8 9 10a) close rangeb) mid rangec) full rangea) obvious soundsb) background soundsc) multi-system connectiona) rhythmic movementb) voicec) memorized
1 2 3 4 5 6 7 8 9 10a) facial (eye-contact)b) body (handshake)c) behavioral (give hug)a) expressions (smile)b) exploratory meaningc) sustained meaninga) interpersonal reaction (laugh at joke)b) spontaneous exchange c) conversational (tell story)
1 2 3 4 5 6 7 8 9 10a) one-step b) two-step c) multi-step a) simple (wave back)b) complexc) sustained complexa) Max Ab) Mod Ac) Min A
1 2 3 4 5 6 7 8 9 10a) greetingb) simple questionc) own namea) one exchangeb) two exchangesc) sustained conversationa) goal-setting (planning)b) group occupation (multi-step)c) problem-solving
1 2 3 4 5 6 7 8 9 10a) emotionb) occupationc) spirituala) emotionb) occupationc) spirituala) emotionb) occupationc) spiritual
Intrapersonal(Self-image)
Interpersonal(Social)
Action
Exploratory Hand Use
Imitative Movements
Habituated Patterns
Organizational(Shared)
Social
Automatic Reponses
Reactive
Collaborative
Identity
Localization(Noticing)
Attention(Sustained)
Sensory Motor(Interactive)
Visual
Orientation (Noticing)
Emotion
Awareness(Mirrored)
Matched(Reciprocal)
Shared(Collaborative)
Memory Care Pattern Video Analysis: Self Awareness
Comments
Scanning(Attention/Focus)
Tracking(Following Mvmt)
Auditory
Time (minutes)Behavior PatternThought Pattern Comments
Thought Pattern Behavior Pattern Time (minutes)
(Becca Jones, Chris Edwards, Krista Robinson, & Josh Fogleman & Janice K. Ryan, 2011)
Collecting Data as Bayesian Inference Probability Statistics:For Enhanced Self-, Social & Spatial Awareness
BayesianInference Probability
+ 1 Affect Broad Focused:Soft Eye Awareness
Characteristic of Positive Emotional States / Postural Stability
Client
+ 1 Affect+ 0 Affect
+ 0 Affect Tightly Focused:
Hard Eye AwarenessCharacteristic of
Negative Emotional States / Postural
Instability
ORBDE Event Codes: Increasing Fitness with the Social Environment
Guastello, S., & Gregson, R. (2011). Nonlinear dynamical systems analysis for the behavioral sciences using real data. NY, NY: CRC Press.
Early Treatment Session:ORBDE Event Codes
Guastello, S., & Gregson, R. (2011). Nonlinear dynamical systems analysis for the behavioral sciences using real data. NY, NY: CRC Press.
Early Treatment Session:ORBDE Event Codes
Guastello, S., & Gregson, R. (2011). Nonlinear dynamical systems analysis for the behavioral sciences using real data. NY, NY: CRC Press.