Reflection

Reflecting on what I have learnt while writing this blog, I can see sensory modulation as a field of occupational therapy practice that would benefit mental health settings in New Zealand. Although I have only explored two aspects of sensory modulation in this blog I am aware of how in-depth sensory modulation can be.

I think one of the most important things that sensory modulation provides for any client is the ability to identify their unique tendencies and preferences, and how these patterns influence self-organisation. Learning skills that can be transferred into other environments encourages the client to use these as ongoing interventions once returning to their own home. I cannot conclusively say that sensory modulation is the best treatment for every client; however I do think that the strategies sensory modulation uses can benefit anyone, even if it is simply providing a relaxing and calm environment for the client.

Occupational therapy is a profession concerned with enabling clients to lead meaningful lives and provide them with the opportunity to engage in daily activities. Sensory modulation provides an opportunity for occupational therapists to promote engagement in therapeutic activities, self care and social participation.

A barrier I can see potentially affecting the set up of sensory rooms in acute mental health services is funding. This must be considered as staff will need to continuously monitor the sensory room and provide their time to setting up the policy and procedures with the clients. The acute service will need a room available that suits the requirements of the sensory room, and there will be additional costs for the equipment. I think this is barrier that can be overcome as the benefits the sensory room provide for the client and the promotion of recovery on the ward will be significant.

I would love to hear your thoughts on my blog so please feel free to comment.

Examining Schizophrenia and Sensory Modulation Disorder

I have just read an article on examining schizophrenia and sensory modulation disorder. The article introduces the concept that sensory modulation disorder is present in clients with schizophrenia. Although the results suggest that adults with schizophrenia also demonstrate sensory modulation disorder, more research needs to be conducted to support this theory.

The research in this article is relevant to occupational therapists as it increases understanding of behaviours related to schizophrenia that interfere with occupational performance, providing opportunities to make unique and valuable contributions to the services and the teams they are working in. Although more research needs to be carried out, people suffering from schizophrenia can benefit from sensory modulation just like all clients with a mental illness. Many individuals with mental health conditions live in a state of fear and disorganization. It is the strategies that focus on increasing individual’s ability to specifically interpret, organise and respond to sensory input that improves recovery for clients. Even if the person does not have sensory modulation disorder, they will still benefit from sensory modulation due to their lack in ability to engage and make the correct responses with their environment.

Unfortunately I was unable to attach the link to the blog; however you should be able to find the article in Google search.

Olsen, L. (2010). Examining schizophrenia and sensory modulation disorder: A review of the literature. American Occupational Therapy Association, Inc.

The following is a list of examples of some of the potential benefits of the use of sensory modulation strategies:

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

Sensory Diet Checklist

A sensory diet should incorporate the following;

•Prevention strategies
•Crisis intervention strategies
•A personalized sensory kit
•The type and amount of support needed to succeed
•Sensory supportive space(s)


I have attached a sensory diet checklist, created by Tina Champagne, of activities people may use or do in order to decrease and/or prevent stress.

http://www.ot-innovations.com/images/stories/PDF_Files/sensory_diet_checklist_2007pdf.pdf

Sensory Diets

“A sensory diet refers to those experiences an individual's system needs in order to self-organise and function throughout each day” (Champagne, 2008). We typically engage in these experiences without consciously knowing the complexity or the purpose they serve, however it is beneficial that we gain an awareness of our own unique way of doing things. Supporting clients to create an individualised sensory diet, will give them an increased self awareness and ability to perform daily tasks.

When creating a sensory diet, it is important to support individuals to consider meaningful and purposeful ideas for both preventative purposes and for use during crisis states. Practice may also be necessary with some of the chosen techniques in order to experience the full benefit. Creating a daily or weekly schedule incorporating those things the person finds most beneficial is one of the ways to begin planning for the implementation of the sensory diet.

Having a planned and scheduled program to meet an individual’s specific need is a concept that I think would work well in a mental health setting. Having a set program, designed to encourage the management of a client’s awareness of their body functions, is a desirable way to implement meaningful and purposeful activities to promote recovery. As occupational therapists need to monitor and evaluate sensory diets, which is a continual process, it provides an opportunity to integrate sensory modulation into community settings.

A great way to provide a calm environment in your sensory room is to play relaxing music. Listen to this youtube clip as see how relaxed you get!!

Tips On Creating A Sensory Room

It is essential to involve both staff and clients in each step of the process to create the perfect sensory room for your service. Meaningful items and themes for rooms can be established through actively involving everyone who will be using the treatment space. No sensory rooms are ever the same because this is not a standard process and it will become a unique and meaningful therapeutic space.

I have provided links to web sites that help to assist with starting up a sensory room. These ideas are not all-inclusive and the ideas presented may not be suitable for all settings or populations.

This is an example of a policy and procedure which is essential for the use of a sensory room. By having this set in place there are clear expectations on the use of the room for all staff and clients.
http://www.ot-innovations.com/images/stories/PDF_Files/demo_sensory_room_policy_2006-1.pdf

This is a list of equipment that can be used in a sensory room.
http://www.ot-innovations.com/pdf_files/Starting_up_sensory_Room_web.pdf

More ideas!!
http://www.sensoryconnectionprogram.com/sensory_room3.pdf

I have just read an article on sensory processing evaluation and intervention in mental health. The article is worth reading if you are able to get hold of it. Unfortunately I was unable to link this to the blog.

The learning objectives of this article include;

1. Recognize the characteristics of sensory processing disorder/ sensory integration dysfunction, including sensory modulation and sensory discrimination problems and how they present in a mental health population.

2. Identify sensory supportive evaluation and intervention approaches targeting sensory modulation and discrimination dysfunction within a mental health population.

3. Identify the occupational therapy practitioner's various roles within the sensory processing initiative in mental health practice.

There is also a case study at the end of the article that illustrates a client who experiences a combination of sensory processing, mental health, trauma, and attachment issues, as well as sensory processing-related occupational therapy evaluation and intervention examples.

Champagne, T., Koomar, J., & Olsen, L. (2010). Sensory processing evaluation and intervention in mental health. OT Practice, 14(10), 15-21.

A Story of Change

I have attached the story of change for Northland DHB and the process they went through when they set up their sensory room. I am going to be working at Whangarei Hospital for my final placement and will be able to experience working in their sensory room which I am really looking forward to.

http://www.tepou.co.nz/knowledge-exchange/stories-of-change/view/listing/45/

Sensory Rooms

The idea to use sensory rooms in acute inpatient mental health settings is a recent development, incorporating a variety of sensory modulation strategies.

“An essential part of this mission is to maintain an emphasis on engaging in meaningful therapeutic activities and in recognizing the inter-relatedness and importance of the therapeutic use of self and physical environment. Offering humane and self-nurturing choices for prevention and crisis de-escalation, is essential and afforded in an organized and safe manner through therapeutic exchanges in sensory modulation rooms” (Champagne, 2008).

Sensory rooms are therapeutic spaces specifically designed to promote sensory modulation and create a stimulating and calming atmosphere that facilitate self-organisation and positive change. “It’s a room where clinicians can work with service users who might be feeling anxious or wound-up and need to be calmed, or others feeling depressed who need to be stimulated,” (Mitchell, 2010). Sensory rooms also offer opportunities for self-discovery and meaningful therapeutic activities. The use of sensory rooms for individual and group treatment for clients help to link skills learned in the hospital environment and transfer these learned sensory strategies to clients home environments.

“A number of DHBs in New Zealand have set up dedicated sensory rooms within their acute mental health units to accommodate the practice of sensory modulation" (Mitchell, 2010). I see this as an exciting development as sensory rooms are beneficial for client recovery. Having a quiet, safe and respectful place of retreat is much more supportive for client recovery than seclusion.

Predominantly sensory rooms;

• Help to create a safe space 

• Facilitate the therapeutic alliance
• Provide opportunities for engagement in prevention and crisis de-escalation strategies, as well as a host of other therapeutic exchanges (to teach skills, offer a variety of therapeutic activities, etc.)
• Promote self-care/self-nurturance, resilience & recovery

Reducing Seclusion

I have attached a link below of an article from the nursing review, which talks about sensory modulation as a prevention method to reduce seclusion in mental health acute settings. From my experiences, working in a mental health acute ward is somewhat daunting, especially to a student and most probably to any other outsider. All doors are locked; everything feels bland, dark and cold. In the unit I worked in there didn’t appear to be anything for the clients to participate in as the art room was mainly closed and the lounge was small and crowded. Clients were left in seclusion. I couldn’t see myself recovering quickly in this sort of environment, so I have a hard time seeing how the clients are encouraged to. Predominantly acute wards have a medical model focus, and lack any recovery approach. From an occupational therapy student perspective, seclusion has no therapeutic benefit and leaves the client feeling hopeless. This results in indefinite dependence on the mental health system, and can lead to reliance on medications to control a clients illness and life. In this case sensory modulation is beneficial in mental health practice as it promotes participation in meaningful occupational and enables clients to uses strategies to control their own recovery.

http://www.nursingreview.co.nz/pages/section/article.php?s=Features&idArticle=17440


I have attached Te Pou’s website on sensory modulation for seclusion reduction in New Zealand, which I think is worth looking at.

http://www.tepou.co.nz/page/398-our-projects+sensory-modulation-for-seclusion-reduction

Here is a link to a page on Te Pou's website introducing sensory modulation in New Zealand.

http://www.tepou.co.nz/page/891-our-projects+sensory-modulation-for-seclusion-reduction+background-to-sensory-modulation-in-new-zealand.

What is Sensory Modulation?

It has surprised me that there is little information and literature written about sensory modulation (as opposed to sensory integration). This is why the concept confused me to begin with as I was unaware of the difference between the two. I wondered if using sensory integration notions would work the same within sensory modulation. Through my experience using these tools with mentally unwell clients I think that they can, if they are used within the right context and at the right level of arousal. Of course you are not going to put an adult client with a mental illness on a scooter board, but our senses are all the same and by understanding how these work and affect our sensory systems, you become aware of how this could impact on ones engagement in life.

On my placement I only learnt how sensory modulation was implemented and the benefits it created to increase client recovery, and was given little theory direction from my colleagues. This made it challenging to define sensory modulation and I was unable to find a definition that was used predominantly within the literature. I have used a reference found in OT-innovations, a website I will be referring to in this blog.

Miller, Reisman, McIntosh & Simon (2001) refer to sensory modulation as, "the capacity to regulate and organize the degree, intensity and nature of responses to sensory input in a graded and adaptive manner. This allows the individual to achieve and maintain an optimal range of performance and to adapt to challenges in daily life" (p. 57).

Sensory modulation is a tool that encourages calm by changing an individual’s sensory experience. We all have five senses (some maybe six!) that help us interact with the world. We all use our senses in different ways, some of us are very aware of our senses, and some hardly even noticing the impact they have. Before I was an occupational therapy student, I myself did not know the impact our senses have on our ability to engage in meaningful life activities. Having experienced using sensory modulation among clients with a mental illness, I see the importance of being conscious of our individual senses, as they influence our performance ability.

Many of the clients I worked with were either over or under aroused, potentially affecting their mental state. Behaviors associated with over-arousal include agitation, anxiety, withdrawal, and difficulty with transitioning from one activity or environment to another. Individuals experiencing under-arousal may appear unengaged or disinterested, or they may engage in activities that increase input (Miller et al, 2007).

Each individual uses different strategies to self-organise in order to achieve and maintain optimal performance and adapt to challenges faced in daily life. Being able to self-organise and change the intensity of sensory input, by grading the response to match the environment demand, can produce optimal performance and hopefully be continuously maintained. The tools and strategies used are very transferable and clients are able to use these in their own home.

Welcome

Welcome to my blog about sensory modulation in mental health. My name is Lucy Banks and I am currently in my final year studying towards a Bachelor of Occupational Therapy. During my three years of studying at the School of Occupational Therapy at Otago Polytechnic, I have gained experience in a variety of settings. Mental health is an area that I have become passionate about, and is an area that I see myself working in in the future.

During my fieldwork placement in a paediatric setting, where I was working with children with sensory processing disorder, I was introduced to the concept of sensory modulation used in mental health. Originally, I was unable to differentiate sensory integration and sensory modulation, and was surprised at the concept of applying the same strategies to a different population. After learning more about sensory modulation, and due to my passion in mental health, I quickly became interested and eager to learn more.

Within this blog, I plan to showcase my learning of sensory modulation by drawing from a variety of literature, as well as using my own reflections. I am planning to keep it simple and only explore two strategies that I have found most valuable for improving recovery in clients with a mental illness.