Sensory Stimulation

I think that if I had to pick a favorite group of people to work with, on a professional level, it would be those folks with dementia who are at the latter stage, or “end stage” of the disease.  Now, these are people who are usually totally dependent on others for care, and who spend a good part of their time either sleeping or at a low level of consciousness.  I have spoken to some health-care workers who are uncomfortable with these persons, and often feel sorry for them because of what they can no longer do.  But I prefer to go back to what I’ve learned from the Allen Cognitive Model, and look at what these special persons are still able to do — and what they are still able to give.

One of the complaints I hear frequently from the Activities staff at long-term care facilities where I have worked is that they just don’t know what to do with persons in the latter stages of dementia.  They have a short attention span, and fatigue easily.  They often become over-stimulated in group activities, and can become disruptive as a result.  These are folks that are often seen in the back of the room when musicians or other entertainers come to perform, or during church services, many times sleeping.  And, yet, there is still life in these wonderful people.  They still deserve to be active participants in stimulating and pleasurable pursuits.

Here are some of what persons at Allen Levels 1 can still do:

— Respond to stimuli

—  Track movements with their eyes

—  Vocalize, or produce sounds

—  Can move their extremities some, with help from others

And at Level 2, they:

—  Can sit up, unsupported, for a short period of time

—  Can stand or walk

—  Can move their arms and legs through a full range of motion

—  Can say a few words

—  Can eat some finger foods

There’s another reason for involving these people in activities.  They not only have the benefit of being stimulating and pleasurable, but they also have therapeutic benefits.  Because they spend a good part of their time in bed, or seated in a chair, and because they are dependent on others for their care, they are at risk for some potentially serious health complications.  These include blood clots, contractions, aspiration pneumonia, skin breakdown, and weight loss.  If provided with the proper kind of stimulation, these people can be given the opportunity to have a more enriched quality of life, but actually a longer and healthier one.

A good sensory stimulation program can be developed with the aid of a Physical, Occupational, or Speech therapist.  Then other staff members, including nurse’s aides and activities staff, can be trained to implement the program.  Here are some important things to consider when designing such a program:

—  Use multiple senses to approach an activity that is enjoyed by the person

—  Utilize a large number of familiar sensory experiences

—  Spend no longer than 15 minutes at a time with the person, 2-3 times a day

—  Work with the person in an environment free of distractions

—  Stimulate no more than 1 or 2 senses at a time

—  Try to create a kit that contains a large number of materials that can be used to elicit responses, as well as a description of what responses are to be expected

—  Train caregivers who will be working with the person on a regular basis including family members, nurses’ aides, activity workers, etc.

—  Make sure that all of these caregivers are aware of the therapeutic benefits of such stimulation.

Speaking of the benefits of sensory stimulation, here is a good example.  Persons who are at this stage of dementia often have significant problems swallowing, particularly certain kinds of foods.  Caregivers often find themselves battling against aspiration, or the leakage of foods and/or liquids into the lungs.  Aspiration can result in pneumonia, which can be especially dangerous in someone who can already be rather frail.

And, yet, as a speech pathologist I occasionally find myself being amazed by someone who is a known aspirator, who seems to defy the odds by avoiding pneumonia.  Often one of the reasons for this is because the person is physically active, or very talkative, or in some other way exercises the lungs enough that small amounts of aspirated material can be coughed up before it can become a problem.

One of the ways that we can be of help to the person with advanced dementia, to decrease the risk of pneumonia due to aspiration, is to ensure that his lungs move with sufficient force to enable him to produce a strong cough.  Some of the ways we can do this is to have the person sing a song after a meal, to engage him in conversation, to have him bat at a ball or balloon that is thrown to him, to go for a walk if he’s able, or any number of similar activities.  In this way, not only is the person’s quality of life enhanced, but quite possibly his lifespan as well.

Another possible example of the benefits of sensory stimulation can be seen as a result of engaging the person in simple repetitive motion activities.  By doing something as simple as batting a balloon, or clapping hands in time with a familiar song, it may be possible to avert contracted joints or skin breakdowns.  Helping the person complete range of motion exercises while “dancing” to a well-loved song can prove to be not only enjoyable for both parties, but also therapeutic for other reasons.  And the laughter that is liable to accompany such activity is bound to be music to the ears.

(This post was inspired by materials provided by the Dementia Care Specialists.)

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