Reflection

I have really enjoyed the process of designing this blog and learning about sensory modulation in mental health settings and benefits that it provides for service users. I hope that this blog could be useful for other people who are interested in learning about sensory modulation. I have covered many areas in my blog such as; sensory diets, impact on function, OT perspective, benefits and seclusion and restraint.

Upon reflecting on what I have learnt so far I believe that sensory modulation is beneficial to mental health services and that we as occupational therapists are in a unique position to provide training and education to service users and staff to provide treatment that is more client-centred and an alternative to seclusion and restraint. Sensory modulation promotes engagement in therapeutic activities, self-care, and leisure, all of which are central to occupational therapy.  

Sensory Diets

A sensory diet can be described as "the experience an individuals system needs in order to self-organise and function throughout each day" (Champagne, 2006). We often engage in activities without knowing their complexity or the purposes they serve so it is beneficial to facilitate an increased awareness system to help a client understand and be aware of their unique patterns and preferences. When creating a sensory diet it is important to consider meaningful ideas for both preventative purposes and use during crisis states (Champagne, 2006). The therapist needs to use effective communication skills in order to gather as much information from the client as possible to collect a comprehensive history. Sensory diets are currently being used in many different mental health settings such as treatment plans, crisis prevention plans, activity programmes and many other creative ways. By understanding a persons individual sensory tendencies, crisis and restraint and seclusion can be avoided, ensuring a more client-centered and humane approach.

References
Champagne, T. (2006). Sensory diets. Retrieved from http://www.ot-innovations.com

Functional impact of sensory processing problems

Below are some examples of the functional impact of sensory processing problems:

Tactile Defensiveness:
Strong clothing preferences and avoidances e.g. clothes feeling itchy
Aversion to showers
Aversion to clothes tags or jewellery
Dislike the feeling of bare feet
Discomfort with suprise touch e.g. hugging, hand-shaking
Discomfort with intimate relationships
Vestibular Defensiveness

Riding in car causes vomiting

Poor balance

Aversive to walking down steep stairs

Visual Defensiveness

Sensitivity to visual stimuli e.g. brightness and contrast

Auditory Defensiveness

Defensive to sounds

Distracted when other people are talking

Olfactory/Oral Defensiveness

Nauseated by odours

Extreme food preferences

Praxis

Difficulty learning new skills particularly learning numbers, letters and spatial organisation

Life impact

Discomfort with touch affecting interpersonal behaviour

Discomfort in crowded places

Frequently feel anxious and tense

Avoidance of social events due to need to dress up

Need to maintain own space

Avoid routine medical procedures e.g. shots, dentist

Often describe self as extremely neat, organised, routine orientated

The occupational therapist needs to be aware of the sensory processing problems that could impact on their clients ability to engage in everyday life. For example social events, work, leisure, parenting, and organisation skills. May-Benson (2011) discusses how cccupational therapists are in a unique position to expand their practice into areas where sensory processing issues may impact on people.

References

May-Benson, T. (2011). Understanding the occupational therapy needs of adults with sensory processing disorder. OT Practice, 16(10),13-18.

Short clip about the positive effects of sensory modulation

Interview with an OT

I was lucky enough to interview an occupational therapist who works in mental health. She provided some really interesting insight into her experience of learning about sensory modulation and how she implemented it into her practice.

1. How did you first find out about SM?

I first heard about SM from colleagues (specifically another two OT’s that I worked with) who had completed the Tina Champagne SM Training. Around about this time it became an interested topic by the DHB as they were trying to get the rates of seclusion down and there was a huge emphasis on restraint minimisation across the Mental Health Sector.  Te Pou then carried out a multidisciplinary training workshop after researching SM to try and educate workers. This training was the first I had experienced and that’s when I became interested in how I could use it in practice. I was then lucky enough to be funded to go for the Tina Champagne Training and from there I got ideas of how I could implement it in practice.  

2. Were other staff in the unit receptive to the creation of the sensory room? Did they understand what it was used for?

The staff on the unit were mostly passive about the prospect of a comfort room (it’s not a full sensory room) on the unit. Some saw the relevance in having a quiet space for people to go and rest, others did not really say anything. Once they started seeing the development of it, particularly the carpet going in and the development of the mural, they was more interest but again it was just left to me as an ‘OT thing’. In retrospect I could have explained a bit more about what I was doing and brainstorm ideas for the comfort room, but after giving an initial in-service on sensory modulation there was little interest and some resistance to the topic so I just went ahead with what I thought was best for our clients and our manager was also supportive of this.

3. What were the challenges of creating the sensory room?

The challenges to creating the sensory room were mostly financial. However due to the drive from the DHB around the use of SM we were lucky as an OT department to be given some funds to purchase resources.The service bought us some modalities such as weighted blankets, mink blankets, cd players, massage pads which took a lot of organising time in terms of ordering and collecting which in turn took more time out of my role working with clients. It was good to get the clients involved with choosing the mural and what they wanted on the wall, but I had to make sure it was appropriate and suitable for what we were trying to do i.e. relaxation, calming room. Another challenge was that the room we were using was previously open to the unit at all times so we could not make it a proper Sensory Modulation Room as the guidelines state that it should be locked and used when required with staff aware of usage and patients state on entry and exit from the room. This was not possible to do as the room had to be open all the time for use and due to its previous use. I suppose the other part to the question of did they know what it was used for, if you mean the patients, I think they understood it was a comfort room to calm and relax but I don’t think they understood the whole concept of sensory modulation de-escalation and to be honest that was not primarily what the room was set up for on the unit. I hoped that with time this would be the case as staff became more familiar and saw it being used. 

4. What were the patients experiences of the sensory room? Did they find it beneficial?

A number of the patients would be observed using the room to relax and sleep. We also had a Tai Chi Group in the room every week. The room was also used for 1:1s with the patients. It’s hard to quantify if they found it useful as we had no measure of usage or rating but from talking to patients there was a lot of people who really liked using the room for time out as they found it relaxing and quiet. We did have one patient in particular who was problematic during the night; he would often wake up and disrupt the others. The night shift started using the room and weighted blanket with the patient after myself and his key worker developed a management plan with good results. I think this was actually a bit of a turning point with the staff as some of them could see it working.

5. Has there been any instances where the sensory room has been used instead of restraint/seclusion? If so has it helped the situation?

No documented instances although if someone is beginning to escalate the room is often used for a discussion. This cannot be said because of the room as there are a limited amount of rooms available that are quiet for de escalation purposes anyway. 

6. Do you think that sensory modulation could be used in a variety of different settings?

Yes definitely, for me I think that it works with every individual. I myself find it useful to be aware that I am becoming anxious or agitated or when I feel de motivated and then implementing a strategy to become more calm or alert. I think that people with anxiety/ depressive/ psychotic disorders or children/ adults with attention or hyperactivity disorders benefit most. If you think about SM from a physiological perspective; that heightened arousal comes from your nervous system being in a constant state of fight/ flight or flux (which is evident in a lot of the above disorders) and that this does not always happen because of thought processes that it can also be a body response to its sensory input or previous trauma, it makes sense that talking therapy will not always be affective and that to get someone to a calm state to be able to hear, process and absorb information will then be able to better facilitate talk therapy and reasoning. With people who do not experience the above disorders there is also benefit as everyone experiences life stressors or feels a bit de motivated at times. Knowing how to make yourself more calm or alert can only enhance your experiences associated with daily life.

Benefits of Sensory Modulation

Below is a list of potential benefits of sensory modulation strategies taken from OT-Innovations.com:

• Increased self-awareness
• Increased ability to self-nurture
• Increased resilience
• Increased ability to engage in therapeutic activities
• Increased ability to engage in meaningful life roles
• Increased ability to engage in social activities
• Increased ability to cope with triggers

Sensory Rooms

Sensory rooms promote self-organisation and positive change and allow the service users to engage in therapeutic and meaningful occupaitons (Champagne, 2010). 

Champagne (2010) states that when sensory rooms are used appropriately they:

• Help to create a safe place
• Facilitate the therapeutic alliance
• Provide opportunities for prevention in engagement in prevention and crisis de-escalation strategies
• Promote self-care

Tips for setting up a sensory room:

• Involve staff and service users: It is really important to involve everyone who will be using the treatment space. Sensory rooms aren't all the same and it needs to be unique and meaninful to the people involved.
• Come up with a name for the sensory room: Come up with a name that describes the purpose of the space within the setting.
• Develop policy and procedure: It is important to set clear policies and procedures outlining the equipment and its purposes. As well as ensuring a safe environment for all.

Check out OT-Innovations.com for more ideas and help when setting up a sensory room. 


References

Champagne, T. (2010). Sensory rooms in mental health. Retrieved from http://www.ot-innovations.com/content/view/49/28/