The use of multi-sensory therapy to develop communication skills in those with complex disabilities
Most people automatically develop the communication skills needed to direct activities and gain a level of control within their environment. However, students with physical and learning disabilities may not get the same opportunities to acquire these skills as their peers. When working with these individuals, it is important to recognise more subtle aspects of communication, such as small physical gestures and eye movements, as deliberate communicative acts.
While sensory impairments are commonly associated with physical and learning disabilities, the important senses of smell and touch can often be forgotten in educational environments (Harrison and Ruddle, 1995). At Treloar School and College, for young people with complex physical difficulties, we have found that a wide range of students can benefit from sensory input in these areas. Indeed, the use of a multi-sensory approach can help compensate for a loss or reduction in one or more sensory areas and encourage development of other communication channels.
This approach to learning and experience is not a new concept in schools and colleges, although the therapy members of a multi-disciplinary team often support students from a distance, offering only intermittent support and advice. In contrast, we have found that a full multi-disciplinary approach more effectively reduces the academic focus and enables a truly holistic approach to the development of functional communication skills.
Our multi-sensory communication sessions are jointly planned and run by an occupational therapist (OT), physiotherapists and speech and language therapists (SaLTs), in conjunction with the classroom staff. Students have an allocated session partner who works closely with them from week to week.
The main aim of the sessions is to enable a total communication approach: to accept and respond to all communicative responses from students. This can include facial expressions, eye gaze, vocalisations, gestures, body movements, pointing and speech.
The sessions harness four of the main senses – sight, smell, sounds and touch – each triggering a different response. Our sensory systems provide the basis for stimulating and developing the cognitive learning experiences that can result in new skills, increased confidence and improved self-esteem. Typically, these skills are developed and consolidated from our early life through to adolescence. However, students with physical and learning disabilities will often have perceptual deficits, meaning that sensory information is not correctly interpreted or understood by the brain. A common sensory deficit is reduced proprioception: a diminished awareness of the position of a limb or joint. As a consequence, individuals’ ability to interact normally with the world is reduced, and they may have limited potential and opportunity to allow these skills to develop. A multi-sensory approach provides greater opportunities to experience tactile stimulation in conjunction with other stimuli.
The sessions are held in a multi-sensory environment rather than a standard classroom. This means that students can absorb the ambience of the sessions without the influences and associated expectations of their classroom.
Comfort is crucial to these sessions; it enables students to relax and therefore participate more fully and enjoy the experience. At the beginning of the session, students are asked if they would like to relax on bean bags or have their chairs tilted to create a more informal posture and a change of position. This is particularly important for those students who spend the majority of their day in a fixed position in a wheelchair. The change in position helps relieve pressure areas, stretch out muscles and joints, and stimulate the blood flow and proprioceptive responses in the joints.
Once all the students are comfortable, the main lights are dimmed, whilst still allowing enough light for communication exchange. Additional coloured sensory lighting is linked to music and sensory items, to enable association between sound, colour and experience.
Aromatherapy scents stimulate olfactory senses enabling students to make a connection and create a memory link between the odour and the environment. It has been found that odour memory is improved by familiarity and recognition and therefore encourages the learning process.
Music is used throughout the session to link the elements and give order and pace. The music reflects the characteristics and associated movement of each sensory item.
The main part of the session involves the use of a set number of everyday sensory-rich objects, chosen beforehand from a variety of appropriate items, such as chopsticks, sponges, rollers and feathers. Each stimulus is linked to a specific piece of music that lasts approximately three to five minutes. The items are chosen for their various qualities and textures – for example, soft, rough, fluffy, cold or hard – in order to provide a variety of tactile experiences to the students. Students have the opportunity to choose personal preferences but the same set of items is generally used for a period of weeks in order to aid association with the chosen music.
Developing choice and preferences
Students are encouraged to explore and increase their awareness of different textures against their body by directing their session partner in regards to their personal preferences, such as like/dislike, degree of pressure, speed and preferred area of contact (for example, head, arm, leg, foot or shoulders).
Some students have difficulties in regard to sensory processing which either result in low or high sensitivity levels. Some students present as “tactile defensive”, showing an extreme over sensitivity to tactile stimulation. In these instances, the OT is able to support the session partner to be alert to these issues so that the session progresses on the student’s terms, and his/her choices are recognised and responded to appropriately. The degree of pressure used will be a primary factor in these cases.
Having a physiotherapist as part of the session enables the team to incorporate a choice of therapeutic hand or foot massage into the programme, and help session partners understand the benefits of this kind of contact. The massage aims to improve students’ awareness of their own body by promoting a positive body image and supporting their sense of self-worth. Proprioception is also stimulated by putting deep pressure through the joints. Moreover, the firm touch of the hand or foot massage also helps to release any joint and muscle tightness. The affects are far greater than during routine, practical activities involving touch – such as dressing or feeding – because this form of therapeutic touch releases endorphins into the brain which foster a sense of health and wellbeing.
The session concludes with a period of relaxation, in order to calm the senses after high levels of sensory activity and communicative exchanges. Some students benefit from being enclosed in a soft blanket to create a sense of security, warmth and comfort. The period of relaxation is a quiet time of soft music and low sensory lighting which enhances students’ return to equilibrium.
The success of the sessions relies on the specific channelled attention of the session partner and his/her ability to interpret, respond accordingly to, and reinforce students’ communication responses. The use of an allocated session partner for each student ensures consistency, especially when a student’s communication is subtle and idiosyncratic. Within one session, one student may be using small body movements while another may be using eye gaze or a combination of different methods. A total communication approach is therefore essential. Non-verbal communication is often regarded as a secondary method of interaction but for those with limited or no speech, methods which utilise facial expressions, eye gaze and small physical gestures become their primary form of communication.
Learning to recognise these communicative acts within a multi-sensory environment, without any emphasis on academic achievement, is the basis of these sessions. The speech and language therapist already has an established therapeutic relationship with the students in the session and is able to support the session partners to establish the skills to identify all aspects of a student’s communication. Once these skills have been gained, they can then be generalised by session partners into other settings across the school and college day. The expertise of the session partners can then be transferred to other members of the multi-disciplinary team, ensuring that the students’ communicative acts are recognised and acted upon.
The emphasis on having one partner working regularly with each student also helps promote shared meaning and understanding. Being a responsive partner requires concentration and focus, as failing to respond to a communicative act is a lost opportunity for potential learning and development. This can also lead to feelings of frustration and low self-worth for the student. Trust is an essential element in the staff-student relationship and it takes time to emerge. Within these sessions, relationships are developed and strengthened, but on the student’s terms. Having weekly sessions also supports this through frequency and repetition in a safe and familiar environment.
Student progress and levels of engagement are recorded at the end of each session. This includes all communicative acts, maintenance of attention and physical responses.
The overall aims of the sessions are to facilitate and encourage interaction, communication, health and wellbeing. As students are encouraged to exercise greater choice, they are able to exert more control over their activities, the environment they engage in and the people they interact with.
There has been a very positive response from students to these multi-sensory sessions. Some students are now taking a more proactive approach to the sensory stimuli, style of interaction and music used. This level of direction has been greater than expected from these students; this demonstrates that when provided with an opportunity to control a situation, students are able to develop the necessary skills. Our aim is for them now to be able to transfer these skills in to their day-to-day lives and activities.
This article was written by Sandra Ferne (speech and language therapist) with her colleagues Amanda Anderson (occupational therapist), Bryony Ashworth and Julia Poole (physiotherapists), Claire Dudden and Pippa Bailey (speech and language therapists) in the Therapy Department at Treloar School and College, Alton, Hampshire: