Dementia Literature Review

A. Jean Ayres. Ayres’ was an occupational therapist that was responsible for the foundation and practice of sensory integration theory (W&S). Sensory integration theory is used to explain behavior, plan intervention, and predict how behavior will change through intervention (Roley et al., 2007). Ayres’ focus was on the organization of the central nervous system and how it was involved in the process of children using sensory information. Ayres’ theory of sensory integration describes how the neurological process relates to the recognition and organization of sensation from the body and environment (Devlin et al., 2010). This disorganization can lead to problems with learning, development, and behavior and also has a negative impact on occupational performance. In relation to the topic of Wilbargers’ DPPT, the focus of the articles collected was related to theoretical research on one particular sensory modulation problem defined by Ayres: tactile defensiveness. Tactile defensiveness is exhibited through the negative influence of touch avoidance symptoms (Moore & Henry, 2002). The aim of the Wilbargers’ DPPT is to utilize the connection between the client’s tactile sensation through the skin and nervous system to improve and normalize the sensation of

In long term care homes in Canada, the Alzheimer Society states that there are more than 500,000 people who have been diagnosed with dementia. (Alzheimer, 2012, p,1) This is a disease that affects one’s brain and is characterized by “changes in the cognitive, psychomotor, emotional and behavioural domains” (Cruz, Marques, Barbosa, Figueiredo, & Sousa, 2011, p.282) of the brain. There has been research done more recently that suggests that a new technology called multi-sensory therapy or Snoezelen therapy may be able to maintain or improve some of the remaining abilities in a patient suffering from dementia such as self-care or communication. Multi-sensory, or interchangeably Snoezelen therapy was developed in the 1970’s by therapists working to find treatments for those with mental illness. “Their intention was to provide people who had sensory and learning disabilities the opportunity for relaxation and leisure experience.” (Burns, Cox, & Plant, 2000, p.120) The concept of Snoezelen aims to stimulate senses without the need for one to take part in intellectual activity. It also offers patients a ‘failure-free’ approach suggesting that there is no pressure to achieve or succeed. (Burns, et al., 2000, p. 120) To stimulate the senses, Snoezelen uses mixtures of light, smells, taste, and touch accessed through one’s sensory organs being the mouth, nose, eyes, ears, and skin. With the introduction of Snoezelen into the realm of long-term care and dementia, the aim is to

Aromatherapy is an increasingly popular alternative therapy for treating Alzheimer's and dementia. Studies are showing that sensory stimulation can decrease agitation and help improve mood, appetite and overall quality of life. Essential oils are typically used when using aromatherapy. The most common essential oils used in the treatment of Alzheimer's and dementia are lavender, lemon balm, peppermint, rosemary, orange, bergamot, and ylang ylang. Lavender, lemon balm and peppermint have been shown to have to have calming and relaxing effects. One study from the United Kingdom made note of the marked decrease in disturbed behavior they were seeing from dementia patients when a combination of essential oils were used. This led to reduced

Two alternatives used to treat symptoms of AD are massage therapy and aromatherapy. The effect of these treatments are considered calming to a patient that may be hostile due to loss of cognition. Not many scientific studies have been conducted on how massage therapy and aromatherapy are beneficial to treating AD patients. There is need for more studies due to the ever changing nature of understanding massage therapy. There seems to be positive results for treating patients in agitated states using stand alone or combined alternative treatments.

“Sensory processing, (sometimes referred to as “sensory integration” or SI) is a term that describes the way the nervous system receives messages from the senses, and turns them into appropriate motor and behavioral responses,” (“Sensory processing disorder foundation,” 2014). No matter the task we are fulfilling: eating lunch, sitting in a classroom, or walking around at the mall, there is some type of sensation involved. Be it the taste of our food, the sound of people walking by, or the bright lights of a classroom, we are surrounded by sensory stimulation. “Sensory Processing Disorder, (SPD) is a condition that exists when sensory signals do not get organized into appropriate responses,” (“Sensory processing disorder foundation,” 2014). Occupational therapist and developmental psychologist, Dr. Anna Jean Ayres (1920-1989), Ph.D., OTR, was the first to use the term sensory integration dysfunction in 1963 and described it as, “The neurological process that organizes sensation from one’s own body and from the environment and makes it possible to use the body effectively within the environment,” (Ayres, 1972). It is sometimes referred to as a neurological “traffic jam” preventing specific parts of the brain from receiving the sufficient information they need to respond to stimulus in the environment.

Jean Ayres an occupational therapist, developed the theory of sensory integration in 1960 (Smith, S., Mailloux, Z., & Erwin, B. n.d.). Jean Ayres defined sensory integration as “The neurological process that organizes sensations from one’s body and from the environment and makes it possible to use the body effectively in the environment” (Ayres,1989, p. 22). Occupational therapists are trained in adapting the environment to address such individual client needs (What Is Occupational Therapy, (n.d.). Jean Ayres believed that the various sensory systems allow us to successfully interact with the environment (Ayres, 1972, p. 1). Moreover, additional research also suggests that a child requires appropriate levels of arousal, orientation, and attention in order to interact and engage with the environment (Case-Smith & Bryan, 1999).

Future research is needed in the areas of prevention, assessment, and intervention. A greatly structured research project is needed for determining how to prevent or slow dementia. For assessment, establishing multi-disciplinary teams willing to share their knowledge of cognition and hearing is critical. More research is needed for intervention to determine the burden that is placed on a caregiver, as well as how intervention could assist caregivers faced with taking care of an oldest old patient with a hearing loss and dementia.

Though many may see dementia individuals as lifeless on the outside, they continue to have the capacity for the recognition of touch and emotions. Both holding and rubbing of the hand or a more indepth massage, have shown to have positive effects on an individual. The sense of touch can ease agitation,anxiety, isolation, and the feelings of loneliness. Message has also shown to increase one’s alertness and awareness of their surroundings. Something so simple as a touch can make such a difference in someone so fragile and bring peace to their lives in so many ways.

A therapy program targeted to adults 21 years and older, the Sensory Program focuses on sensory integration, rehabilitation, and quality of life (Aptus Treatment Centre, 2016). Sensory integration is the process of absorbing sensory information followed by organizing and assigning meaning to said information, and thus, making it worthwhile (Aptus Treatment Centre, 2016). To respond appropriately and effectively to given sensory input and/or a situation, one experience appropriate sensory integration (Aptus Treatment Centre, 2016). The cliental of Aptus impairments in the way they integrate, process, and organize sensory information, resulting in feelings of confusion, stress and anxiety, frustration and fear (Aptus Treatment Centre, 2016). Thus, the goal of the sensory program is to reduce feels of anxiety, develop coping strategies, and offer opportunities in which to learn self-regulation and self-expression (Aptus Treatment Centre, 2016). As such clients participate in activities such as a period within the “Snoezelen Room,” “relaxation time” and “music” (Aptus Treatment Centre, 2016). The “Snoezelen Room” is an artificially designed space that offers a relaxing environment through soothing lighting, music, gentle vibrations, and tactile sensations (Aptus Treatment Centre, 2016).

Many non-pharmacologic interventions have been identified as effective for managing behaviors and psychotic symptoms of dementia. These interventions aim to prevent and manage the incidence of agitation, aggression, and other dementia related behaviors. These interventions should be patient centered, focusing on individualized patient needs. Non-pharmacological approaches can include aromatherapy, sensory stimulations, light therapy, herbal medicine, acupuncture, homeopathy, osteopathy, chiropractic and reflexology ("Non-pharmacological Therapies for the Treatment of Behavioral Symptoms in People with Dementia," 2005). Resident’s physical and basics needs should be met in order to maximize participation in treatments. In the year 2000, The Mental Health Foundation conducted a study where 2 groups of people with dementia had a lotion containing either lemon balm or sunflower oil rubbed onto their upper body extremities twice daily. The study found that people with lemon balm showed a decrease in agitation compared to those with the sunflower oil ("Non-pharmacological Therapies for the Treatment of Behavioral Symptoms in People with Dementia," 2005). According to Curtins (2010) a study completed by Hulme et el, examined the effects of music therapy on certain behaviors including agitation, aggression, wandering, restlessness, and nutritional intake in dementia residents. The study found Music therapy to be effective in reducing these symptoms (Curtin, 2010). Studies have also shown aromatherapy given in conjunction with massage therapy reduced ‘wandering’ in people with dementia. Lavender oil, delivered via aroma steam, was shown to reduce agitation ("Non-pharmacological Therapies for the Treatment of Behavioral Symptoms in People with Dementia," 2005). Non-pharmacological strategies have been proven effecting in improving mood and decreasing the occurrence and the length

While we are students, learning to become occupational therapists, we are often going to come across a condition that we are unaware of and want to learn more about. For us, we came across Sensory Processing Disorder (SPD), and did not know much about it. We understood that SPD had an impact on a child’s ability to take in sensory information and affect how his or her brain reacts to it. However, we did not know how it affected a child in their day-to-day living, so we developed a clinical question of ‘how does sensory processing disorder affected children in their everyday life?’

Current sensory integration theory proposes that a very wide array of difficulties and maladaptive behaviors can derive from disordered sensory processing. Sensory Processing Disorders are further categorized as issues of hypersensitivity, hyposensitivity, and sensory discrimination. These disturbances of processing are recognized as potentially occurring in any sensory modality, be it visual, auditory, olfactory, tactile, gustatory, proprioceptive, or other interceptive

Sensory Integration Therapy (SIT), a form of occupational therapy, uses exercises to strengthen the patients’ ability to sense touch, balance, and a sense of where the body is in relation to objects in space (MedicineNet, 2017). It is important that SIT is performed by a licensed occupational therapist in a structured, repetitive manner. This is because repetitive activities will aid the child’s nervous system to respond in a more organized way to sensations and movement. This type of therapy, within occupational therapy, can be used to treat patients that are overly sensitive or under reactive to touch, movement, sights, or sounds, unusually high or low activity levels, poor attention span, and poor body awareness. Types of sensory integration therapy include deep pressure, vestibular, noise, and visual techniques. For example, if a child is struggling with stability, the occupational therapist could use a swing as a form of SIT to improve their balance. Likewise, a patient who has difficulty visualizing might be prescribed SIT in the form of lights and moving objects.

The debate surrounding sensory processing disorder or sensory integration disorder is not a new but is growing within the medical and education fields. Many feel that sensory processing disorder is just the next “it” diagnosis. Others feel that sensory processing disorder is a real and effects many children. Research surrounding sensory processing disorder by itself is limited. Often, the research involving sensory processing is conducted with other disabilities or illnesses. The issues surrounding sensory processing disorder are:

Claire (OT) provided Zelna and Stanley, Jean-Louis’s parents with the Sensory Profile caregiver questionnaire to complete in their own time and Zelna has returned for marking prior to appointment. Sensory processing is our ability to determine a range of sensory information such as sight, sound, smell, movement and touch within the brain. Sometimes one or more of the senses may be under or over reactive to stimulation/sensation and thus a child may be under or over aroused. For learning, it is important to be in an optimum state of arousal. The Sensory Profile is a caregiver questionnaire that contains statements about children’s responses to sensory events in daily life.