Partial proceeds from this training goes to the Hidden Angel Foundation

1. Multi Sensory Environment (MSE) Training SENSORIUM 1 Partial proceeds from this training goes to the Hidden Angel Foundation (c) Fornes, 2009

2. SENSORIUM 1 INTRODUCTION Rationale and purpose OVERVIEW OF MSE Definition, history, and benefits of MSE OVERVIEW OF NEUROANATOMY AND THE SENSES Sensory processing and the senses, (c) Fornes, 2009

3. SENSORIUM 1 INTRODUCTION Rationale and purpose (c) Fornes, 2009

4. It is all about the ENVIRONMENT We take the environment for granted. On a daily and moment by moment bases we interact with our environment (c) Fornes, 2009

5. “There are no guarantees in life, except that everyone faces struggles. This is how we learn (and grow). Some face struggles from the moment they are born. They are the most special of all people, requiring the most care and compassion and reminding us that love is the sole purpose of life” - Elisabeth Kubler-Ross These are our Hidden Angels teaching all of us life’s most valuable lessons. (c) Fornes, 2009

6. (c) Fornes, 2009

7. The Purpose The main objective is that through the use of MSE, quality of life, health, and social well-being of people with various challenges will be enhanced. The purpose of this training is: First, to provide a definition and overview of MSE, discuss new developments and converging themes around MSE, why MSE maybe have positive outcomes, and build a theoretical framework and delivery model of MSE. Second, provide tools, protocols and hands-on experience for effective used of the equipment to achieve our main objective. (c) Fornes, 2009

8. DISABILITY DEFINED • MSE can be beneficial for all children • Yet, important for people with disabilities because essential services and educational tools are needed to improve learning, social integration, and quality of life for children with disabilities. • People with disabilities constitute the largest minority group for whom access to public places, education, and the political sphere is still limited • “Society creates a handicap [disability] when it fails to accommodate the diversity of all its members,” when attitudinal and environmental barriers prevent “full, equal and active participation in society”. • Thus, disability is a social construct and one that can be changed. (c) Fornes, 2009

9. DISABILITY DEFINED • When physical barriers are removed, attitudinal barriers are nil leading to community inclusion. • MSE may be seen as a tool to remove physical and attitudinal barriers. • People with disabilities simply have different challenges and different capabilities. Everybody has possibilities and potential (c) Fornes, 2009

10. “There are no guarantees in life, except that everyone faces struggles. This is how we learn (and grow). Some face struggles from the moment they are born. They are the most special of all people, requiring the most care and compassion and reminding us that love is the sole purpose of life” - Elisabeth Kubler-Ross “People with a developmental disability often have the unique capacity to touch our lives. They have gifts of welcome and spontaneity, and their sensitivity to matters of the heart allows them to break the barriers, to enrich and challenge us as human beings.” --- L. Arche Noah Sealth, Seattle (c) Fornes, 2009

11. MSE and COMMUNICATION • People with disabilities are exceptional at giving lessons on the appreciation of simplicity and the meaning of love and caring • Sometimes we fail to learn these lessons because we fail to understand the language. • People with disability see the environment differently and have a different form of communication. • It may be through the experience of our senses that we are better able to communicate and to be understood. • An MSE opens up the means to this kind of communication and understanding. As we begin to learn the language, barriers are broken and inclusion takes place. (c) Fornes, 2009

12. Sensory stimulation is a basic human need that is essential to life and survival. We must assist those who are unable to access sensory stimulation on their own due to disabilities and/or impoverished environments. MSE can provide such essential stimulation and indeed, can be seen as the medium through which an individual lives. The Need for MSE MSE provides a whole new world for individuals with cognitive, emotional, and physical challenges (c) Fornes, 2009

13. The Rationale for a MSE Sensory stimulation enriches our lives. A person will fail to thrive - and often withdraw - when their environment offers nothing. People with cognitive, emotional, and physical challenges rarely, if ever, experience the world as the majority of us do Limitations of movement, vision, hearing, cognitive ability, behavioral difficulties, perception issues, pain, and other problems limit ability to interact with and control their surroundings. The level of function achieved by an individual is a reflection of the stimulation and opportunities afforded the individual by his or her environment. An individual must be provided with a great enough stimulation to get through even the poorest sensory channel Stimulation that is produced in the sufficient frequency, intensity, and duration, Increases brain arousal, Improves the organization of the brain, and Permits increased functional activity. (c) Fornes, 2009

14. The Rationale for a MSE • MSE provides new ways of: • Encouraging learning • Motor and cognitive development • Language and social interaction skills • MSE has been shown to increase: • Awareness, concentration, and alertness • Brain arousal • Exploration • Choice • Mental and physical relaxation • Enjoyment • Improved Social Well Being and Quality of Life (c) Fornes, 2009

15. The Problem Throughout Europe, Israel, Australia MSE has been around for 40 years, as a learning environment and therapeutic recreational activity, for individuals with: developmental disabilities, intellectual disabilities, profound multiple disabilities, and cognitive challenges, autism , traumatic brain injury, dementia, Alzheimer's, emotional and mental challenges, chronic pain syndrome, coma, and relaxation for people without disabilities. Yet , MSE in special education and as an activity for individual with disabilities is limited in the USA. Due to limited Empirical Research and lack of a theoretical foundation. Given the observed and qualitative benefits of MSE, empirical research and a tested theoretical foundation would strength the argument of the benefits, as well as add to the body of knowledge in complementary theories such as neuroplasticity and life quality. (c) Fornes, 2009

16. Sensorium 1 MSE Overview History Definition Benefits of MSE (c) Fornes, 2009

17. Multi Sensory Environments - The History Cleland and Clark – 1966 • Sensory Cafeterias • To advance individuals with cognitive and behavioral impairments Verheul and Hulsegge (Netherlands) – 1970 • Snoezelen • To enrich the living and life of individuals with sever cognitive impairments and disabilities. A concept of recreation/relaxation for disabled adults. AAMSE (American Assoc. of MultiSensory Environment) - 2006 • Today MultiSensory Environments benefiting every age and targets individuals with cognitive and physical disabilities, brain injury, dementia, young children, etc. Today Sensory concepts extended into all aspects of life (c) Fornes, 2009

18. Multi Sensory Environments - The History The concept was defined in the late 1970’s by two Dutch therapists, Ad Verheul and Jan Hulsegge, while working at the De Hartenberg Institute in Holland, a center for people with intellectual disabilities. Hulsegge and Verheul gave the concept a name, the word “Snoezelen”, a contraction of the Dutch verbs “snuffelen” – to seek out, sniff out, or explore – and “doezelen” – to relax. (c) Fornes, 2009

19. Multi Sensory Environments (MSE) - Defined The sensory input we take for granted every second -- seeing, hearing, touching, moving, and more – is vitally important to individuals challenged with mental or developmental disabilities. A MSE is a dedicated space or room where multiple sensory stimulation is used as an educational tool or recreational activity for individuals with severe disabilities in order to increase brain activity and as a result, enrich their lives. Designed with two goals in mind: to promote intellectual activity and to encourage relaxation. Controlled environments designed for active or passive interaction, and matched to fit the perceived motivation, interests, leisure, relaxation and/or educational needs of the user. • MSEcan be used to: • Calm • Relax • Stimulate • Empower • Enjoy • Enrich (c) Fornes, 2009

20. Multi Sensory Environments (MSE) - Defined MSE is a dynamic pool of Intellectual Property (IP) developed over 35 years. The multi sensory environment IP is a medium for communication that centers around a natural process of multi sensory stimulation that is accessible, demand-free, choice-driven, empowering, meaningful, and pleasurable, based on the needs and interest of the person with respect, equality, and human dignity. This MSE multidimensional IP platform can be used in different applications including recreation and leisure, education, and treatment. • MSEcan be used to: • Calm • Relax • Stimulate • Empower • Enjoy • Enrich (c) Fornes, 2009

21. Multi Sensory Environments (MSE) - Defined The goal, in all applications, is for the multi sensory stimulation to change brain arousal to improve neurological physiology and functional ability leading to improved communication, quality of life, and well-being. The multi sensory stimulation approach can be tailored in intensity and frequency of stimulation to individual thresholds (consisting of auditory, visual, tactile, gustatory, olfactory, and kinetic modes) in an attempt to increase arousal and awareness and elicit a meaningful behavioral response. MSE provides a feedback loop where a facilitator makes observations and keeps the individual engaged in the MSE experience. The feedback loop allows for each MSE experience to be different and suited to the individual. • MSEcan be used to: • Calm • Relax • Stimulate • Empower • Enjoy • Enrich (c) Fornes, 2009

22. (c) Fornes, 2009

23. Groups for MSE Three groups benefit from the use of multi sensory stimulation: those with profound disabilities who, because of a disability, have limited opportunity to access multi sensory stimulation on their own, such as people with mental retardation, dementia, learning disabilities, etc., Their sensory experience is limited. those who may have sensory processing challenges and need varying sensory stimulation in order to process self-regulation, such as people with autism. those without disabilities where multi sensory stimulation and experiencing the environment is a basis for learning and relaxation, such as infants and preschool children. (c) Fornes, 2009

24. WHY CREATE AN MSE ? (c) Fornes, 2009

25. Children and adults with disabilities and other complex conditions often find the world confusing, boring, restrictive, and over or under stimulating. This leads to stress, dependence, lack of control and/or sensory deprivation. SENSORY EXPERIENCE • “ The average person touches 300 different surfacesevery 30 minutes……” • “ The average person with a profound disability will likely touch 1 – 5 surfaces in the • same timeframe ” For Example (c) Fornes, 2009

26. SENSORY EXPERIENCE • “ People need to understand that behavior is always communication, it is always telling us something.” • Lorna Jean King • Centre for Study of Autism (c) Fornes, 2009

27. SENSORY DEPRIVATION • Impaired functionality • Impaired cognitive skills • Lowered sensory acuity • Limited memory • Limited focus • Low engagement • Reduced opportunities • for personal interaction • Leads to behavioral challenges • “ Our sensory diet needs are similar to our nutritional diet needs. We need the right combination of sensory input to keep an optimal level of alertness and performance. ” • Patricia Wilbarger • OTR June 1995, • Sensory Integration (c) Fornes, 2009

28. SENSORY DEFENSIVENESS as defined by Patricia Wilbarger • a constellation of symptoms concerning aversive or defensive reactions to non-noxious stimuli across one or more sensory modalities • reaction involves primitive survival and arousal mechanisms which have a potentially negative effect on every aspect of a person’s life. • Two components of Sensory Defensiveness are Sensory Defensive Behavior or Emotional Behaviors (Affective Disorders) (c) Fornes, 2009

29. Mild Sensory Defensiveness a normal system pushed to extreme. these people are considered “Touchy”, “Slightly Picky”, and “Slightly Controlling” they can be close with relatives and a few close friends they can be affectionate with loved ones, have a social life and recreational pursuits • Moderate Sensory Defensiveness • two or more areas of life are involved, primarily self-care and relationships • categorized by seeking and avoiding behavior, with extreme control of the sensory environment • intimacy is difficult and is with only a trusted few • they can be thought of as “Controlling”, “Compulsive”, “Phobic”, “Anxious”, “Avoiding”, and often suffer from “Stress and Anxiety Disorders” an/or “Sleep Disorders”. • they typically avoid crowds, shopping, movies, theaters, elevators, and any extraneous noise Severe Sensory Defensiveness • all aspects of life are affected • they have rigid routines, often can not work, if at all, only in sheltered work • they are very isolative, avoid particular sensory input or seek out a particular input, and are often self-abusive • they would be considered “psychotic” or near “psychotic” (c) Fornes, 2009

30. The Features of MSE MSE feature equipment focusing on visual, tactile, auditory, olfactory, gustatory and proprioception stimulation including: Interactive tactile walls Sound walls and floors Bubble tubes Fiber optics Ball pools Mirror balls Soft floors, water beds, cushioned bases Effect projectors Vibroacoustics Music and sounds • A relaxed atmosphere • Pleasant surroundings • Soothing sounds • Intriguing aroma • Interesting lighting effects • Comfortable seating • Choice of sensations • Opportunities for interaction • and engagement (c) Fornes, 2009

31. Sensorium 1 Benefits of MSE (c) Fornes, 2009

32. The Value of MSE • New ways of encouraging learning, motor development, cognitive development, language and social interaction skills Alternative and powerful forms of sensory stimulation for individuals who have previously been isolated in their perceptual disabilities • A whole new world for individuals with cognitive, emotional, and physical challenges (c) Fornes, 2009

33. Who benefits (c) Fornes, 2009

34. Who Benefits from MSE Individuals with: Autism Cerebral Palsy Profound multiple disabilities Developmental disabilities Chronic Pain Syndrome Hearing Impairment ADHD (Attention Deficit Hyperactivity Disorder) and ADD (Attention Deficit Disorder) Pervasive developmental delays Mental dysfunction Brain injury Stroke Coma Alzheimer's and Dementia (c) Fornes, 2009

35. (c) Fornes, 2009

36. Illustrative Results of MSE Enable and empower children and adults with significant disabilities. Provides a pleasurable experience of a variety of sensory motor activities Produces an atmosphere of trust and relaxation or heightened awareness Promotes self-choice Increases concentration, awareness, and alertness Improves coordination and motor development Enhances cognitive development and increased brain function Encourages more social interactions and more vocalization Induces relaxation and less stress Increases opportunity for choice and self-determination Relives pain (c) Fornes, 2009

37. Anecdote 1 Subject: “Tom” Situation: Subject to violent, aggressive outbreaks, hurting mother Courts were considering institutionalizing Lynall Application: OT works with Tom in a MSE room 6 months for 30 mins a day – 4 days / week. Observation: After 6 months, no more violent outbreaks, was accomplishing tasks no one realized he could do, and his medication was reduced. Today: He now lives in the community with his mother and was never placed in an institution. The above anecdotes are intended to illustrate the impact of a multi sensory environment. They are not intended to suggest cause/effect. . (c) Fornes, 2009

38. Anecdote 2 Subject: “Gary” Situation: 5 year old boy with, Autism non-commutative, non- verbal. Application: He enjoyed using the cube (a switching devise) to influence and control his environment. Used the MSE in an educational setting, 20 to 30 minutes daily. Observation: After the first few session, Gary, at age 5, said his first word and from their his communication skills have improved significantly. Today: Attending school and is interacting with parents and other children. The above anecdotes are intended to illustrate the impact of a multi sensory environment. They are not intended to suggest cause/effect. (c) Fornes, 2009

39. Anecdote 3 Subject: “Susan” Situation: 1 year old girl with profound mental retardation, suffered a stroke at 3 months. Was severely withdrawn, non reactive, poor feeding, failure to thrive. Application: Staff, caregivers and parents provided daily multi sensory stimulation in the MSE as well as stimulating activities throughout the day. Observation: Susan became more reactive, started to smile and recognized caregivers, gained weight. Today: At age 2 is progressing, happy and has an improved quality of life. The above anecdotes are intended to illustrate the impact of a multi sensory environment. They are not intended to suggest cause/effect. . (c) Fornes, 2009

40. Multi Sensory Enrichment Multi Sensory Enrichment provides alternative resources for professionals and practitioners to work purposefully and effectively with people with severe and profound disabilities. By adapting and modifying the environment we enable and empower children and adults with significant disabilities. Multi Sensory Enrichment: (a) provides a pleasurable experience of a variety of sensory motor activities, (b) produces an atmosphere of trust and relaxation or heightened awareness, and (c) promotes self-choice opportunities. Encourages learning and improves one’s quality of life. (c) Fornes, 2009

41. Why is MSE Important for Development and Learning Our sensory system it the window to the brain Sensory experience is a precursor to all development Multi sensory experiences affect our motivation, attitudes, emotions, learning, physical activities and our very being. The constant stream of data obtained through our senses gives us vital tools to survive and thrive. (c) Fornes, 2009

42. MSE and Development By working towards a better organized, stronger, and more efficient nervous system, individuals become better able to demonstrate and access their true potential. The ultimate goal of MSE is to facilitate recovery or improvement of the nervous system so that individuals are able to process information of increasing variety and complexity. Multi sensory stimulation is essential for individuals with disabilities, where sensory pathways are stressed and had not formed the appropriate connections. (c) Fornes, 2009

43. A MSE Continuum to Learning and Development Sensory deprivation due to limitations or sensory issues All learning involves the senses Senses are the only way to communicate with the world Increased self-choice & independence Increases Brain Arousal Life Enrichment Improves Social well-being. Improved Health Improves Development Failure to thrive Fosters learning Fosters Communication Changes Behavior Increases Relaxation (c) Fornes, 2009

44. SENSORIUM 1 Overview of Neuroanatomy and the Senses (c) Fornes, 2009

45. The Olfactory Nerve Olfactory Stimulation The sense of smell is the olfactory sense. The olfactory receptors are cells on hairs extending from the ends of the olfactory bulbs. The smell receptors are stimulated by gaseous molecules, although the exact mechanism is unknown. The afferent pathways for smell funnel directly to the brain through the limbic system, displaying the primitiveness of this sense organ. Thus, smell has a more direct route to the brain than other senses. (c) Fornes, 2009

46. The Gustatory Nerve Gustatory Stimulation The perception of taste is augmented by smell and touch. To a person whose nostrils are shut tight, a raw apple tastes the same as a raw potato. There are four primary tastes – sweet, sour, salt, and bitter. The taste receptors are in taste buds distributed around the tongue. The number of taste buds decreases with age. (c) Fornes, 2009

47. The Auditory Nerve Auditory Stimulation Auditory stimulations, the stimuli for hearing, are vibrations (sound waves) transmitted through the air. The vibrations stimulate nerve fibers in the ear, which generate impulses. The nerve impulses terminate in the auditory area of the temporal lobes of the brain and sound is thus perceived. (c) Fornes, 2009

48. The Visual System Visual Stimulation Visual stimuli are created by fibers in the eye responding to direct stimulation as well as to stimulation of neighboring fibers. If a receptor is responding to a weak stimulus but a nearby receptor is responding to a stronger stimulus, the weaker response will be inhibited by the stronger. The effect of this is to accentuate borders and contours (i.e., differences) and to obscure uniform fields (i.e., habituation). Lateral inhibition functions for the cutaneous, auditory, and gustatory modalities. There are environmental cues to which the organism is prewired to respond, presumably those cues that are most necessary for survival (Kaufman, 1987). (c) Fornes, 2009

49. Tactile Nerve • Tactile Stimulation • Touch is crucial to human survival, and plays an important role in our emotional development, creation of memories, and connecting with our environment. • The sense of touch is the ability to distinguish various objects through touch and pressure. • Tactile sensations arise from receptors located in the skin that fire when touching or being touched. • Touch is the mother of all sensory systems. The human finger is so sensitive it can detect a surface bump just one micron high, while the human eye can’t resolve anything much smaller than 100 microns. • Touch is an ancient sense in evolution: even the simplest single-celled organisms can feel when something brushes up against them and will respond by nudging closer or pulling away. • While we can perceive something visually or acoustically from a distance and without really trying, if we want to learn about something tactilely, we must make a move, we must rub the fabric. • While the sensory receptors for sight, vision, smell, and taste are clustered together in the head, conveniently close to the brain, touch receptors are scattered throughout the skin and muscle tissue and must convey their signals by way of the spinal cord. (c) Fornes, 2009

50. Touch One three quarter inch square patch of skin contains • Touch provide the brain with body boundaries so we can differentiate “me” from “not me” • Tactile Sensations are processed in two separate and distinct touch systems that make it possible for us to differentiate light touch from pressure touch (Sometimes referred to as Deep Touch). • 9’ of blood vessels • 30 hairs • 300 sweat glands • 4 oil glands • 13 yards of nerves • 9000 nerve endings • 6 cold sensors • 36 heat sensors • 75 pressure sensors • 600 pain sensors (c) Fornes, 2009