Slide 1

Partial proceeds from this training goes to the Hidden Angel Foundation

Multi Sensory Environment (MSE) TrainingSENSORIUM 1 11/8/20091(c) Fornes, 20091SENSORIUM 1INTRODUCTIONRationale and purpose

OVERVIEW OF MSEDefinition, history, and benefits of MSE

OVERVIEW OF NEUROANATOMY AND THE SENSESSensory processing and the senses,

11/8/20092(c) Fornes, 2009SENSORIUM 1INTRODUCTIONRationale and purpose

11/8/20093(c) Fornes, 2009

It is all about the ENVIRONMENTWe take the environment for granted. On a daily and moment by moment bases we interact with our environment11/8/20094(c) Fornes, 2009These are our Hidden Angels teaching all of us lifes most valuable lessons.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 11/8/20095(c) Fornes, 20095

11/8/20096(c) Fornes, 2009The PurposeThe 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.

11/8/20097(c) Fornes, 2009The purpose of this training is to share the findings that identify new developments and converging themes around MSE leading to the development of a theoretical framework and delivery model of MSE. This framework also provides direction for future research. The aim is that through the use of MSE, quality of life, health, and social well-being of people with various challenges will be enhanced.

7DISABILITY 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.

11/8/20098(c) Fornes, 2009While MSE is beneficial for all children, the initial focus is on disability because essential services and educational tools are needed to improve learning, social integration, and quality of life for children with disabilities. People with disabilities may constitute the largest minority group for whom access to public places and education is still limited. In spite of the Americans with Disabilities Act of 1990 people with disabilities still experience barriers that limit their access to participation in leisure activities and, often, appropriate education.The United Nations defines disability by commenting that society creates a 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. By this definition, disability is a social construct and one that can be changed.An excellent example of such a social construct can be found on Marthas Vineyard, a small island off the coast of Massachusetts, where in colonial days it was normal to be deaf (Groce, 1985). Some early Vineyard settlers carried a gene for deafness, and over years of marriage, generations were born with hearing loss. At one point, one in four children was born deaf! Because of the large deaf population all the residents of the Vineyard learned sign language. Sign language was used so freely and easily by both deaf and hearing residents that deafness was never considered to be a disability (Groce, 1985). 8

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 potential11/8/20099(c) Fornes, 2009This is a great example of Universal Design, where everyone in the community interacts with the environment equally. Because all physical barriers have been removed, attitudinal barriers are nil and community inclusion occurs automatically. MSE may be seen as a tool to remove physical and attitudinal barriers

9There 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

11/8/200910(c) Fornes, 2009It is very important that we recognize that every human being is equal, and persons with disabilities simply have different challenges and different capabilities. Everybody has possibilities and potential, including individuals with disabilities as illustrated by the following quotations:

10MSE 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.

11/8/200911(c) Fornes, 2009People with disabilities are exceptional at giving lessons on the appreciation of simplicity and the meaning of love and caring, yet many of us fail to learn these lessons because we fail to understand the language. When an individual is unable to communicate verbally, this does not mean that their cognitive ability to understand is nonexistent. These people see the environment differently and have a different form of communication. Sometimes 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 take the time and attempt to understand their language, barriers are broken and inclusion takes place.

11Sensory 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.

MSE provides a whole new world for individuals with cognitive, emotional, and physical challenges 11/8/200912The Need for MSE

(c) Fornes, 2009Sensory 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.

11/8/200913The Rationale for a MSE(c) Fornes, 200913 MSE offer people with cognitive impairments and other challenging conditions the opportunity to enjoy and control a variety of sensory experiences.

These populations rarely, if ever, experience the world as the majority of us do. Limitations of movement, vision, hearing, cognitive ability, constrained space, behavioral difficulties, perception issues, pain, and other problems create obstacles to their enjoyment of life. multi sensory stimulation provides opportunities for bridging these barriers.

A relaxing experience and exploration is provided under the guidance of a caregiver or enabler. Effects in a Multi sensory room can be directly controlled by the participants or enabler, or set to run automatically. Participants experience self-control, autonomous discovery, and exploration-achievement that overcome inhibitions, enhance self-esteem, and reduces tension.MSE provides new ways of:Encouraging learningMotor and cognitive developmentLanguage and social interaction skills

MSE has been shown to increase:Awareness, concentration, and alertnessBrain arousalExplorationChoiceMental and physical relaxationEnjoyment

Improved Social Well Being and Quality of LifeThe Rationale for a MSE11/8/200914(c) Fornes, 2009 Multi sensory environments provide new ways of encouraging learning, motor development, cognitive development, language and social interaction skills. Multi Sensory Enrichment has been shown to increase awareness, brain arousal, exploration of ones environment, choice, mental and physical relaxation, enjoyment, and improved social-well begin and quality of life.

14The ProblemThroughout 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.

11/8/200915(c) Fornes, 200915 For the past 30 years throughout Europe, Multi sensory environments have been used as an educational tool and leisure activity for individuals with intellectual disabilities. Today, in Europe, Multi Sensory Enrichment is being used in learning environments and as a therapeutic recreational activity for individuals with developmental disabilities, autism, TBI, dementia, Alzheimers, people with emotional and mental challenges as well as relaxation for individuals without disabilities. Yet, the use of MSE in the USA in special education or as an activity for individuals with disabilities is minimal. It is interesting to note that the U.S. Government, in 2008, deemed that limiting sensory experience for prisoners of Guantanamo Bay as a form of torture. Yet, this same government has failed to provide sensory stimulating environments for individuals with profound disabilities who are unable to access sensory stimulation and unable to easily interact with their environment. Thus, there is a need for MSE for individual with various disabilities and for those in impoverished environments.

The minimal usage of Multi Sensory Enrichment in the United States may be due to limited empirical research and a lack of a theoretical foundation. Most research around MSE today has been based on subjective observation and generally has not been objectively measured. Research and formal evaluations of MSE meet resistance in Europe because there is fear of forcing individuals with disabilities into more structured, oriented therapy, in contrast to freely chosen recreation. Unfortunately, all too often, activities for those with disabilities have to be justified on therapeutic grounds, although no one disputes the importance of play and self-selected activities for normal developing children nor our own leisure pursuits.

Given the observed benefits of MSE for individuals with disabilities, research would strength the argument and add to the body of knowledge around theories in special education, therapeutic recreation, neuroscience and life quality.

Sensorium 1MSE OverviewHistoryDefinitionBenefits of MSE11/8/200916(c) Fornes, 2009Multi Sensory Environments - The HistoryCleland and Clark 1966Sensory CafeteriasTo advance individuals with cognitive and behavioral impairments

Verheul and Hulsegge (Netherlands) 1970SnoezelenTo 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) - 2006Today 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

11/8/200917(c) Fornes, 200917The theory around the positive affects of multi-sensory stimulation originated with two American psychologist, Cleland and Clark. These psychologists promoted the possibilities of improving development, communications and behavioral changes of individuals with developmental disabilities through stimulation of the senses. Cleland and Clarks Sensory Cafeterias were appropriately arranged rooms where individual could see, hear, smell and feel experiences to stimulate the senses. PAUSEIn the mid 70s, Verheul and Hulsegge of the Netherlands, working with individuals with severe disabilities, further developed the concept of multi-sensory stimulation. Their multi-sensory environments is called Snoezelen. Snoezelen is derived from the words snufflen (to search, seek out and explore) and doezelen (to relax). Snoezelen is a multi functional concept in which a specially designed room is created mainly to provide stimuli to awaken and release sensory perceptions. PAUSEMulti-sensory stimulation, or Snoezelen as it is called in Europe, has been utilized in Israel and Europe over the last 15 to 30 years respectively. Although, the establishment and use of multi-sensory environments in North America has been limited. Practitioners are just beginning to discover the positive effects of multi sensory rooms.The AMSEA is an association recently formed in the US to promote the ideas, concepts, usage and research around MSE.Twenty-five years ago, multi-sensory environments were used solely for people with mental disabilities. Today MSE benefits every age and target group.

The concept was defined in the late 1970s 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.

Multi Sensory Environments - The History11/8/200918(c) Fornes, 2009Multi Sensory Environments (MSE) - Defined

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.

11/8/200919(c) Fornes, 2009MSE can be used to: Calm Relax Stimulate Empower Enjoy EnrichThe 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. 19A multi sensory environment (MSE) is a safe, nonthreatening, dedicated space (or room) designed to promote intellectual activity, heighten awareness and brain arousal, and encourage relaxation. MSE is engineered to bring together multi sensory equipment to stimulate the sensory pathways of touch, taste, sight, sound, smell, and movement without the need for intellectual reasoning or direct neural pathways. Multi sensory stimulation produces either a calming effect on individuals prone to frustration or stimulation to passive individuals who appear withdrawn (Mertens, 1999). In a multi sensory environment, stimulation can be intensified, reduced, presented in isolation or combination, packaged for active or passive interaction, and matched to fit the motivation, interests, and recreational/educational needs of the user.A multi sensory environment should be a demand-free environment where individuals can select and experience sensory stimulation on their own, with respect and dignity. Experience is limited when it is not completely controlled by the individual. Only the individual knows internally (and unconsciously) what makes him or her feel good. The MSE needs to provide opportunities for the person to experience the room on his or her own terms.

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. 11/8/200920(c) Fornes, 2009MSE can be used to: Calm Relax Stimulate Empower Enjoy Enrich20A multi sensory environment (MSE) is a safe, nonthreatening, dedicated space (or room) designed to promote intellectual activity, heighten awareness and brain arousal, and encourage relaxation. MSE is engineered to bring together multi sensory equipment to stimulate the sensory pathways of touch, taste, sight, sound, smell, and movement without the need for intellectual reasoning or direct neural pathways. Multi sensory stimulation produces either a calming effect on individuals prone to frustration or stimulation to passive individuals who appear withdrawn (Mertens, 1999). In a multi sensory environment, stimulation can be intensified, reduced, presented in isolation or combination, packaged for active or passive interaction, and matched to fit the motivation, interests, and recreational/educational needs of the user.A multi sensory environment should be a demand-free environment where individuals can select and experience sensory stimulation on their own, with respect and dignity. Experience is limited when it is not completely controlled by the individual. Only the individual knows internally (and unconsciously) what makes him or her feel good. The MSE needs to provide opportunities for the person to experience the room on his or her own terms.

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.11/8/200921(c) Fornes, 2009MSE can be used to: Calm Relax Stimulate Empower Enjoy Enrich21A multi sensory environment (MSE) is a safe, nonthreatening, dedicated space (or room) designed to promote intellectual activity, heighten awareness and brain arousal, and encourage relaxation. MSE is engineered to bring together multi sensory equipment to stimulate the sensory pathways of touch, taste, sight, sound, smell, and movement without the need for intellectual reasoning or direct neural pathways. Multi sensory stimulation produces either a calming effect on individuals prone to frustration or stimulation to passive individuals who appear withdrawn (Mertens, 1999). In a multi sensory environment, stimulation can be intensified, reduced, presented in isolation or combination, packaged for active or passive interaction, and matched to fit the motivation, interests, and recreational/educational needs of the user.A multi sensory environment should be a demand-free environment where individuals can select and experience sensory stimulation on their own, with respect and dignity. Experience is limited when it is not completely controlled by the individual. Only the individual knows internally (and unconsciously) what makes him or her feel good. The MSE needs to provide opportunities for the person to experience the room on his or her own terms.

Multi-Sensory Environment

Concepts: Choice Driven, Demand Free, Empowering

Slide By: Linda MessbauerRelaxationLearningTreatmentPromoting the relaxation continuum from Distraction to the Neuro-physiological state of Relaxation

Promoting a continuum of exploration to teaching & setting learning objectives with outcomes. Allows for multiple styles of learning

Utilized with various treatment techniques based on current Theory and Best Practices for that specific Diagnostic category.

11/8/200922(c) Fornes, 2009Empower the individual to touch, feel, try. this is how we learn. Yet we control some of the environment to avoid harm. For example: When a mother tells a child not to touch the stove because it is hot, what does the child do, touches the stove. The child learns from this experience what hot is, the child learns from experience the environment, not by the mother telling the child. We learn from our enviornment and our experiences in the environment. Yet, the mother learns that she now needs to control the childs environment, by making sure the stove is off when the child is around. Thus we need to give demand-free choice in the MSE, yet control the environment in a way that the child learns from the environment.22Groups for MSEThree 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.

11/8/200923(c) Fornes, 2009

WHY CREATE AN MSE ?11/8/2009(c) Fornes, 2009SENSORY EXPERIENCEChildren 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.

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

11/8/200925(c) Fornes, 2009

People need to understand that behavior is always communication, it is always telling us something.

Lorna Jean King Centre for Study of AutismSENSORY EXPERIENCE11/8/200926(c) Fornes, 2009SENSORY DEPRIVATION Impaired functionality Impaired cognitive skills Lowered sensory acuity Limited memory Limited focus Low engagement Reduced opportunities for personal interactionLeads 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 WilbargerOTR June 1995, Sensory Integration

11/8/200927(c) Fornes, 2009 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 persons life.

Two components of Sensory Defensiveness are Sensory Defensive Behavior or Emotional Behaviors (Affective Disorders) SENSORY DEFENSIVENESS11/8/200928(c) Fornes, 2009Mild 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 Defensivenesstwo or more areas of life are involved, primarily self-care and relationshipscategorized by seeking and avoiding behavior, with extreme control of the sensory environmentintimacy is difficult and is with only a trusted fewthey 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 Defensivenessall aspects of life are affectedthey have rigid routines, often can not work, if at all, only in sheltered workthey are very isolative, avoid particular sensory input or seek out a particular input, and are often self-abusivethey would be considered psychotic or near psychotic11/8/200929(c) Fornes, 2009The Features of MSEInteractive tactile wallsSound walls and floorsBubble tubesFiber opticsBall poolsMirror ballsSoft floors, water beds, cushioned basesEffect projectors VibroacousticsMusic and sounds30

MSE feature equipment focusing on visual, tactile, auditory, olfactory, gustatory and proprioception stimulation including:11/8/2009(c) Fornes, 2009A relaxed atmosphere Pleasant surroundings Soothing sounds Intriguing aroma Interesting lighting effects Comfortable seating Choice of sensations Opportunities for interaction and engagement30A MSE is a safe and non-threatening environment taking an individual on a journey through sensory pathways which many people with cognitive impairments may not experience in every-day life. MSE are designed to stimulate the primary senses of touch, taste, sight, sound, smell and feelings without the need for intellectual reasoning. Built to promote learning, exercise, and relaxation, a myriad of lighting effects, shapes, textures, aromas, soft music and color are strategically place in a room to stimulate the senses and to enhance neurological, cognitive development and mobility leading to the advancement of education and recreation for special need populations. Sensorium 1Benefits of MSE 11/8/200931(c) Fornes, 2009The Value of MSEAlternative and powerful forms of sensory stimulation for individuals who have previously been isolated in their perceptual disabilities32New ways of encouraging learning, motor development, cognitive development, language and social interaction skillsA whole new world for individuals with cognitive, emotional, and physical challenges 11/8/2009(c) Fornes, 200932multi sensory environments provide alternative and powerful forms of sensory stimulation for individuals who have previously been isolated in their perceptual disabilities, providing new ways of encouraging learning, motor development, cognitive development, language and social interaction skills. multi sensory rooms can open up a whole new world for individuals with cognitive and physical impairments by providing stimulating environment.

Who benefits11/8/200933(c) Fornes, 2009Who Benefits from MSEIndividuals with:

AutismCerebral PalsyProfound multiple disabilities Developmental disabilities Chronic Pain SyndromeHearing ImpairmentADHD (Attention Deficit Hyperactivity Disorder) and ADD (Attention Deficit Disorder)Pervasive developmental delays Mental dysfunctionBrain injuryStroke ComaAlzheimer's and Dementia

3411/8/2009(c) Fornes, 2009

34 MSE offer people with cognitive impairments and other challenging conditions the opportunity to enjoy and control a variety of sensory experiences.

These populations rarely, if ever, experience the world as the majority of us do. Limitations of movement, vision, hearing, cognitive ability, constrained space, behavioral difficulties, perception issues, pain, and other problems create obstacles to their enjoyment of life. multi sensory stimulation provides opportunities for bridging these barriers.

A relaxing experience and exploration is provided under the guidance of a caregiver or enabler. Effects in a Multi sensory room can be directly controlled by the participants or enabler, or set to run automatically. Participants experience self-control, autonomous discovery, and exploration-achievement that overcome inhibitions, enhance self-esteem, and reduces tension.

11/8/2009(c) Fornes, 200935Illustrative Results of MSE Enable and empower children and adults with significant disabilities.Provides a pleasurable experience of a variety of sensory motor activitiesProduces an atmosphere of trust and relaxation or heightened awarenessPromotes self-choiceIncreases concentration, awareness, and alertnessImproves coordination and motor development Enhances cognitive development and increased brain function Encourages more social interactions and more vocalizationInduces relaxation and less stressIncreases opportunity for choice and self-determination Relives pain3611/8/2009(c) Fornes, 200936The positive effects of multi sensory rooms for those with neurological impairments have widely been reported. Sensory organs have often been referred to as the window to the brain and a functional nervous system. multi sensory stimulation aids in cognition and the development of a functional nervous system by stimulating it in a consistent and organized way through a series of sensory activities and movement. By working towards a better-organized, stronger and more efficient nervous system, individuals become better able to demonstrate and to access their true potential. The rationale is that exposure to frequent and various sensory stimulation will facilitate both dendritic growth and improve synaptic connectivity in those with damaged nervous systems, leading to improved cognitive functioning and environmental interaction.The level of function achieved by an individual is a reflection of the stimulation and opportunities afforded the individual by his or her environment. When the environment offers nothing the individual fails to thrive and often enters a state of withdrawal. Studies have shown that young children, individuals with disabilities, and elderly persons are especially vulnerable to the failure to thrive.Time spent in a sensory room has been shown to increase concentration, focused attention, alertness, calmness, and heightened awareness of the surrounding world. Individuals also appear happier while in a sensory room and tend to vocalize more, stay on task and are more creative. For those with self-injurious or autistic behaviors, the gentle stimulation has a soothing effect and helps relieve agitation, aggression and promotes relaxation; stress levels drop dramatically. Anecdote 1Subject: Tom

Situation: Subject to violent, aggressive outbreaks, hurting motherCourts 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.

.3711/8/2009(c) Fornes, 200937The positive effects of multi sensory rooms for those with neurological impairments have widely been reported. Sensory organs have often been referred to as the window to the brain and a functional nervous system. multi sensory stimulation aids in cognition and the development of a functional nervous system by stimulating it in a consistent and organized way through a series of sensory activities and movement. By working towards a better-organized, stronger and more efficient nervous system, individuals become better able to demonstrate and to access their true potential. The rationale is that exposure to frequent and various sensory stimulation will facilitate both dendritic growth and improve synaptic connectivity in those with damaged nervous systems, leading to improved cognitive functioning and environmental interaction.The level of function achieved by an individual is a reflection of the stimulation and opportunities afforded the individual by his or her environment. When the environment offers nothing the individual fails to thrive and often enters a state of withdrawal. Studies have shown that young children, individuals with disabilities, and elderly persons are especially vulnerable to the failure to thrive.Time spent in a sensory room has been shown to increase concentration, focused attention, alertness, calmness, and heightened awareness of the surrounding world. Individuals also appear happier while in a sensory room and tend to vocalize more, stay on task and are more creative. For those with self-injurious or autistic behaviors, the gentle stimulation has a soothing effect and helps relieve agitation, aggression and promotes relaxation; stress levels drop dramatically. 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.

3811/8/2009(c) Fornes, 200938 . Anecdote 3Subject: 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 animproved 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.

.3911/8/2009(c) Fornes, 200939 . Multi Sensory EnrichmentMulti 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 ones quality of life.

11/8/200940(c) Fornes, 2009MSE offer people with cognitive impairments and other challenging conditions the opportunity to enjoy and control a variety of sensory experiences.

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 ones quality of life.40Why 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.

11/8/200941(c) Fornes, 200941Sensory experience, the window to the brain, is a precursor to all development including physical, cognitive, social, and communicative. On daily and moment by moment basis, multi sensory experiences affect our motivation, attitudes, emotions, learning, physical activities, and our very being. It is through our senses that we learn and develop an understanding of our environment. The maturation of ones nervous system continues to develop during the first six years of life and is dependent upon the successful stimulation of the nervous system via sensory organs. The constant stream of data obtained through our senses helps the brain to interpret our surroundings, giving us vital tools to survive and thrive. Functional and cognitive development takes place as the nervous system matures. Failure to mature may be due to a disability or impoverished environment where stimulation of the senses is impaired or nonexistent. This lack of sensory input further affects ones disability.MSE and DevelopmentBy 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.

11/8/200942(c) Fornes, 2009By 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. Any program that puts an individual through an intensive period of sensory stimulation that uses repeated movement, sounds, and visual exercises helps slowly create new neural pathways in the brain where there were none and to take over for damaged or underdeveloped pathways. Multi sensory stimulation is essential for individuals with mental retardation, traumatic brain injury, and learning disabilities, where sensory pathways are stressed and had not formed the appropriate connections.

42A MSE Continuum to Learning and DevelopmentLife EnrichmentImproves Social well-being. Improved HealthIncreases RelaxationFosters CommunicationFosters learningFailure to thriveImproves Development Changes BehaviorSensory deprivation due to limitations or sensory issuesAll learning involves the sensesSenses are the only way to communicate with the worldIncreased self-choice & independenceIncreases Brain Arousal11/8/200943(c) Fornes, 2009When an organism is exposed to a new pattern of signal (sensory input) from the external environment, the strength of synaptic contacts and local biochemical and electro properties gradually change in complex distributed constellation. This represents learning. Sensory signals in different modalities can interact with one another, giving rise to may multisensory phenomena. Multi sensory stimulation becomes a vehicle for learning and further shapes learning. When experiencing sensations, an organism is made more responsive to certain aspects of its environment, and through this arousing experience learning occurs. MSE awakens interest, and individuals in this enriched environment begin to explore and discover their surroundings. This exploration acts as a stepping-stone towards learning and has exponential benefits.

43SENSORIUM 1Overview of Neuroanatomy and the Senses11/8/200944(c) Fornes, 2009 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.11/8/200945(c) Fornes, 2009 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.11/8/200946(c) Fornes, 2009 The Auditory NerveAuditory 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.

11/8/200947(c) Fornes, 2009The 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).11/8/200948(c) Fornes, 2009Tactile NerveTactile StimulationTouch 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 cant 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.11/8/200949(c) Fornes, 2009Touch 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).

One three quarter inch square patch of skin contains9 of blood vessels30 hairs300 sweat glands4 oil glands13 yards of nerves9000 nerve endings6 cold sensors36 heat sensors75 pressure sensors600 pain sensors

11/8/200950(c) Fornes, 2009 Light touch system carries:a primitive system and dominant sensation.

Carries pain, temperature, tickle, itch, and scratch

the sensations tend to spread rapidly making it difficult to tell precisely where the original contact was made

your response is to most naturally avoid the sensation.

it is a Dominant sensation. Its pathways lead to the RS, Limbic System and ANS

it can tripwire strong sympathetic response to activate and energize (produce High Arousal) for possible Fright, Flight, or Fight

it is an evaluative system: Is it new?, Do we Care?, Are we concerned?

11/8/200951(c) Fornes, 2009Pressure touch system carries:Carries vibration, and joint and muscle sensations

its a newer system and is discrete, the sensations tend to be precise. We can tell where contact was made, when it started and stopped and how hard it is

this sensation is usually approached.

it is a Subordinate sensation and pathways go to areas of the brain that gives us a vague sense of what it is and then to the cortex for precise identification. It inspires us to learn and explore. It calms and organizes us

it triggers parasympathetic responses to counteract sympathetic arousal and calm us

11/8/200952(c) Fornes, 2009The Vestibulor Ocular Reflex

Vestibular Stimulation

Vestibular sensations arise from firing of the vestibular apparatus in the inner ear and influence ones movement and motion. The vestibular system talks to and influences every other system. Vestibular perception or sense of gravity provides input to the middle ear and its balance mechanism, including activity such as rolling, swinging, seesaw, merry-go-round, and other rocking activities. Some people will become dizzy and nauseous; others will show no reaction

11/8/200953(c) Fornes, 2009Vestibular sensations:arise from firing of the vestibular apparatus in each inner ear.

tell the brain we are moving, surrounded by something that is moving, on something that is moving, or a combination of the three.

tell the brain where down is because the vestibular apparatus registers the pull of gravityThe Vestibular system talks to and influences every other system11/8/200954(c) Fornes, 2009Proprioception

Proprioception Stimulation

Proprioceptive sensation is tied to receptors embedded in muscles, tendons, and ligaments that help us identify where body parts are in space. Proprioceptive sensations help us feel grounded, secure, organized, settled, and calm. The best proprioceptive sensory feedback is active movement of the muscles and joints and when the muscles contract against resistance. Some children will crave these activities and others will show no reaction. Activities that encourage proprioception are jumping, hopping, or tumbling. Every effort of voluntarily walking, standing, or running gives motion to the body and is directed by a sense of the condition of the muscles. Without this sense we could not regulate the actions of the muscles.

11/8/200955(c) Fornes, 2009Proprioceptive sensations:arise from firing in tiny receptors located in muscles, tendons, and ligaments that surround joints

tell the brain where body parts are and what they are doing without our having to look

provide the sense of our body contents.

Proprioceptive sensations help us feel grounded, secure, organized, settled, and calm. Movement is needed to keep the Proprioceptors from going to sleep. The best proprioceptive sensory feedback is active movement of the muscles and joints and when the muscles contract against resistance11/8/200956(c) Fornes, 2009The Sensory System Two sensory systems, the dorsal column medial lemniscal system and the spinothalamic system, use three neurons to convey sensory information from peripheral sensory receptors to conscious levels of cerebral cortex .

1) Dorsal column medial lemniscal system: Carries sensory informatioin for discriminative touch, joint position sense, vibratory, and pressure sensations from the trunk and limbs.

2) Spinothalamic system: Carries pain, temperature, and crude touch sensations from the extremities and trunk.11/8/200957(c) Fornes, 2009Dorsal Column Pathway

11/8/200958(c) Fornes, 2009Spinothalamic Tract

11/8/200959(c) Fornes, 2009Sensory Processing

11/8/2009(c) Fornes, 200960

Sensory Processing Sensory Processing allows us to take in and make sense of many different kinds of sensations coming into the brain through different sensory receptors and channels at the same time. Our ability to respond and function is dependent upon adequate and accurate sensory processing and help us to plan and execute adaptive responses to different challenges in order to learn and function in daily life.

The sensations ultimately are responsible for much of how we learn to function. They are not often thought about consciously and are taken for granted.

These sensations produce automatic responses and included vestibular, proprioceptive and tactile sensations.

the MSE environment alone brings about the relaxation process without any conscious effort by the individual; experiencing it is sufficient

this makes it a most powerful treatment modality for severely disabled individuals and a first step in treating Sensory Defensiveness11/8/200961(c) Fornes, 2009

11/8/200962(c) Fornes, 2009The following definition is from The Sensory Integration Perspective, Course 1 of the Comprehensive Program in Sensory Integration sponsored by University of Southern California Department of Occupational Therapy and Western Psychological Services, Feb. 2001.Sensory Modulation:1. Neuromodulation a process by which the CNS adapts its output to a continuously changing internal and external environment (Miller & Lane, 2000)2. Enables the CNS to regulate behavioral responses to sensory stimuli3. Sensory modulation is a type of neuromodulatory process involving the adjustment of neural messages that convey information about the intensity, frequency, duration, complexity, and novelty of sensory stimuli (Miller & Lane, 2000)4. If modulation is not working well, the person is unresponsive to sensory stimuli, craves excessive amounts of stimulation, or overwhelmed and distressed by sensory stimuli5. Linked to arousal level, which may be too low or too high if sensory modulation is not working well6. If working well, allows a person to notice relevant stimuli and filter out unimportant stimuli7. Contributes to self-regulation (ability of person to self-manage emotions & behavior)8. Probably related to sensitization, habituation, and other facilitory and inhibitory processes in the CNS (Miller & Lane, 2000)The following definition is from The Sensory Integration Perspective, Course 1 of the Comprehensive Program in Sensory Integration sponsored by University of Southern California Department of Occupational Therapy and Western Psychological Services, Feb. 2001.Sensory Modulation:1. Neuromodulation a process by which the CNS adapts its output to a continuously changing internal and external environment (Miller & Lane, 2000)2. Enables the CNS to regulate behavioral responses to sensory stimuli3. Sensory modulation is a type of neuromodulatory process involving the adjustment of neural messages that convey information about the intensity, frequency, duration, complexity, and novelty of sensory stimuli (Miller & Lane, 2000)4. If modulation is not working well, the person is unresponsive to sensory stimuli, craves excessive amounts of stimulation, or overwhelmed and distressed by sensory stimuli5. Linked to arousal level, which may be too low or too high if sensory modulation is not working well6. If working well, allows a person to notice relevant stimuli and filter out unimportant stimuli7. Contributes to self-regulation (ability of person to self-manage emotions & behavior)8. Probably related to sensitization, habituation, and other facilitory and inhibitory processes in the CNS (Miller & Lane, 2000)

62Our InspirationChristopher Douglas Fornes (1981-2006)

1

For further information:

Sandra Fornesphone: 205-594-4875fax: 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.11/8/200963(c) Fornes, 200963