Setting Targets
Sensory stimulation could be described as ‘encouraging the senses’ we use our senses to communicate with other people, to understand the environment and ourselves. Just looking at pictures, touching a wall and smelling the flowers, are all achieved due to the control we have over our senses.
For people with learning disabilities the world can be confusing and difficult to come to terms with if it is hard to look, difficult to hear or even frightening to touch!
We gain our information about the world around us by using all our senses together, not just one in isolation. So ‘multi-modal’ stimulation is appropriate but beware of bombardment.
For example: In the multi sensory room or studio (MSR) you are presented with fibre optics. You first of all look at them, then listen to them, then touch them and you may even ask questions like ‘how does it work?’
It is worth noting that you ‘interacted’ with the fibre optics in a multi-modal manner. ‘Multi-modal’ is a term often used when describing communication, but we explore in a multi-modal manner, in other words we are using all of our senses’.
Ascertaining a student’s ability can only be achieved through some kind of baseline assessment of the student’s sensory skills. We may then find the best and most appropriate way to stimulate the student’s senses. When working with a student with profound and multiple disabilities there are some key points we must remember.
We use the senses to make our world clearer and to enable us to:
• Communicate with people.
• Understand the environment.
• Understanding ourselves.
People may have difficulties:
• Receiving information.
• Giving information
• Understanding the information.
• Communicating the understanding of the information.
• Making an appropriate response.
• Using the information.
Many adults and children will need to ‘practice’ with their senses; in the same way we practice a new language. Often the work is repetitive and sometimes boring for the staff but this can be outweighed by the gains we can make for both the student and staff.
Student (child/adult):
• More self awareness
• Increased attention span
• Control over the environment.
• Improved communication skills.
• Choices.
• Reduction of challenging behaviour.
Staff:
• Reduction of challenging behaviour.
• More interesting sessions
• Target achievement
• Progression
• Improved communication with the student
The following chart was compiled by Susan Fowler OT, Melbourne, Australia.
The sense Information gained
• Seeing (Visual) The environment
• Hearing (Auditory) The environment
• Touch (Tactile) Ourselves & the environment
• Smell (Olfactory) The environment
• Taste (Gustatory) The environment
• Movement Ourselves
How?
In this example let us consider a student (she) with visual loss and hearing, movement, communication and cognitive difficulties.
The information we are trying to gain is varied. We need to know the student’s, sensory skills, communication and cognitive abilities. But if we are trying to find a starting point, the first step is to discover the student’s likes and
dislikes within the multi sensory room. This assessment alone will not answer all the questions, but will begin to assist in the formation of the bigger picture.
We are going to assess the student’s initial responses to fibre optics. The assessment could be carried out in any environment, maybe darker/lighter, with a different person, different equipment etc. These variables make
assessments more complex, however much more information is gained in this manner.
The following is a chart devised by the Occupational Therapist, Susan Fowler (Melbourne, Australia). Some people may argue that the chart is old fashioned and a one shot assessment. But this kind of assessment is informative if repeated over a number of weeks or months.
Although we are using a visual effect many people with profound and multiple disabilities may be more stimulated by touch and movement, rather than auditory/visual. In most developmental charts touch and movement come before visual and auditory skills. Although people will argue that vision later in life is our major co-coordinating sense.
We are working with individuals and although you can keep this sensory developmental sequence in mind, assess individuals to see which sensory system they prefer. Use this as your “window in” to find activities that are sensorily motivating for them. Then expand from this so that students gain ‘multi-sensory’ experiences.
We may assume that the visual effect from the fibre optics is predominant, so we will study the visual responses first. You could also try using the fibre optics over different backgrounds (light, mid and dark) and note if there is a change in response.
General points:
• If you are working with a student with visual loss and are not aware of the nature of the loss, be mindful that you may need to move the fibres, or present them from the front, side, close, and at a distance. Watch for any discomfort.
• Communicate what is going to happen, how and when. A student may not appear to react simply because they did not know they were supposed to react!
• Make sure the student is in the best position to access the fibre optics and that you give plenty of time for the response (it sometimes takes minutes, not seconds).
• Look for all modes of communication when assessing the response, include examples of non verbal communication
• People may have “off” days.
We are working with a student with severe learning difficulties, we know her well, and we know she has a visual loss, but we are not sure what it is! She looked fleetingly then looked away, hence the X in the box. There was no sign of a prolonged response and she showed little visual interest. In the session no tactile or sound prompts were given together. We wanted to look for the visual response only.
We could move onto the tactile section of the assessment or continue trying to get a ‘look’ at the fibre optics. Considering that we have already established that our sensory system works in a ‘multi modal’ manner we should investigate the other senses before working out our way forward.
Much of our ‘tactile investigation’ is carried out with our hands, but the fibres can also be touched, or wrapped around the body for further tactile stimulation, you may note the student’s tolerance of this. Do this to yourself
first so that you can experience it, and show her there is nothing to be afraid of. Communication will be of utmost importance here, if the student thinks they are hot or electric, she will not touch them or may even react violently if touched with the fibre optics. So show her what you are going to do and make sure he/she is in a good position to receive them.
She tolerated them being placed in her hand, there may have been some
intent to grasp but she showed little sign of visual contact.
A response to sound?
The fibre optics do not inherently make much noise, but maybe the fan in the light source could be noticed, maybe the sound of the fibres being ‘rustled’ in front of her may be a sound clue. You may need to experiment with proximity and volume here, shake the fibres first softly then with more intent. Remember to expect the unexpected, although we are finding out about the hearing, look for a visual response to the activity as well.
Remember to communicate what is going to happen and then stay quiet!
This time she showed a response to the fibres being shaken. It was noted that she turned when the sound came from the side and she looked for the source of the sound. Now we are beginning to build up the picture of the
student. What about the cognitive skills? We may look to answer some of the following questions.
At the moment, none of the last section is apparent. This does not mean that
none are there, just that the student is not communicating the intent!
We may also make notes of the following:
We have not assessed all of the students sensory system, just the responses to that the one item, at one time of day, in one particular situation, with one member of staff! To build a fuller picture we would need to do the same with other items, not just sensory equipment, other situations and other people. Try tactile objects such as soft toys, torches, music or objects. You could find things that the student may apply meaning too, like a spoon or a cup.
For this exercise let us presume you have tried a variation of items in different environments with different staff members. You got the best response to things which light and made sounds. The overall response was comparative to the assessment we carried out with the fibre optics.
• In most visual sessions the student looked fleetingly, then looked away. There was no sign of a prolonged response and showed little visual interest.
• In most tactile sessions the student tolerated things being placed in his/her hand and there may have been some intent to grasp, but showed little sign of visual contact.
• In most sound sessions the student showed a response to the sound. It has been noted that he/she turned when the sound came from the side and he/she looked for the source of the sound. The student also appears to like music.
You obviously know the students you work with and would have very good ideas about sensory and communication abilities before these assessments where documented. But based on this and past information where do we go now?
We need to consider the abilities of the student.
The student has:
• Some visual skills, but may not use them with intent: We gained this information because fleeting glances are given to some things. It should also be said that just because a person does not ‘look’ this does not mean
they have no or little vision she may need more time.
• There is tactile awareness and she responds to objects when they are placed on the body or when prompted to touch with the hands. This is evident as the she tolerates most things but has very little motor control
and often needs assistance.
• Hearing skills may be good and she uses them well to the best of our knowledge.
To encourage all round skills we may use brightly coloured objects in the sensory room and elsewhere in the school or centre and at home. In specific stimulation sessions we will concentrate on interaction with the items we present. The work with the fibre optics and other ‘effects’ will continue. We will be observing the following areas:
• Visual awareness: Look for prolonged responses to visual effects, measure the attention span, look for small improvements. We will also try to find likes and dislikes, position, colour, intensity, distance and size as
this will enable us to formulate the best ‘tools’ to use to stimulate the vision. We will be watching for evidence of eye preference, better left or right? Of fixation, tracking and the range of visual skills. As we have
already established she may have some visual loss, we may already have grounds to request a visual function assessment to be carried out by a professional. This would assist us in presenting effects, which are accessible to the student.
• Tactile awareness: There is a difference between true tactile defensiveness and people not liking touch because they’ve had bad experiences. When working with visual effects we will also encourage the
student to touch the effect (where possible). We would pay particular attention to the reactions to different tactile stimulus and attention span. Hand eye co-ordination may be what we are aiming for then she may
move on to operating switch systems and making choices. That may appear a little distant at he moment, but we will look for that ‘look’ when we present the tactile effects.
• The hearing skills appear to be good, so how can we improve her quality of life and allow him/her to make more use of this sense? The student will need exposure to a wide range of sound, not just music. Environmental
sounds either using the real thing or even sound effects. These could expand the knowledge. Establishing favorite music is always a good idea. Using lots of sound clues for activities (not just the spoken word) will be
helpful.
Overall sensory stimulation will be very important for this student, in other words, more of the same. She needs to gain control and enjoyment from people and the environment. The steps may be small but are in most cases
measurable. With the information we have, and the goals we wish achieve there are many opportunities for ‘stimulation’ both at the centre and at the home. With this many things to goals for and the vast armory of stimulus available to us, the work is great fun.
I have omitted the subject of communication in this paper, but that’s actually what it’s all about. We need our sensory skills ‘great or otherwise’ to communicate. We are encouraging the pre-requisite skills to being an
effective communicator. Encouraging and investigating the student’s communication skills both with people and the environment is the basis for all our work.
If you have carried out a baseline assessment and set your targets then we should also consider the argument of the multi sensory room versus the classroom or day room. Is the student going to benefit from the room or the
tools in the room? Is it the best place for them? Could you use the tools elsewhere? These are all questions you should ask yourself before using the MSR.
Considering that the skills we gain in the room are for use, in the main, out of the room then taking the equipment out may be an excellent way to generalise skills.
We need to consider a format to track our progress our aims and objectives. The following pages describe one of many formats you could use to plan your sessions.
The student information sheet should be completed to give you background knowledge of the student. You will have seen a completed form on the course.
Most of the information required could be gained from the I.E.P. or I.L.P. If you cannot answer any of the questions, you may consider why not? These questions you need to find answers too by using the tools in the MSR.
The aims sheet asks what is your long term aim, then what are you going to do over the next few sessions (short term)? Are there any curriculum (children) or skills (Adults) links? There are many formats used with the rooms
or with individual pieces of equipment however, this example is quite detailed. I like to list the equipment used alongside the senses. This helps me to clarify my aims. Just one last comment the word ‘How’ has been used as it is simple self explanatory, and does not confuse everybody. Remember that your aim need to be relatively short term and detailed. I you simply write ‘develop communication’ this would be a little too broad for people to understand. Break your work down into logical steps and plan accordingly.
The Outcome sheet is just an on going record of the progress of the student. Simply document what happened in the session, progress made or otherwise will be the main things here. You may also include changes in the equipment you made in the session. Although this document is very important keep this fairly short. Other staff or inspectors need to be able to read this and find out what you did and what happened in the session. This outcome sheet is the only sheet will need to be filled in after every session. The others change as the student’s targets change.
The aims sheet could include the following information
Name - Date aim started - Long term aim - Short term aim
List equipment needed - Vision - Hearing - Touch - Taste - Smell - Vestibular - Proprioception
And some notes on what you intend to do
©Richard Hirstwood