Have you ever snoezelened?
Multi-sensory stimulation rooms
up in nursing homes all over the country
Bubbles float in tall tubes
of light, soft music oozes from the cushions, images
of bunnies, deer, and waterfalls drift past your eyes.
Sound like a bad acid trip?
They should be so lucky. It's actually something called
a Snoezelen or multi-sensory stimulation room for people
with cognitive impairment.
The rooms are environments
that use sensory stimulation like sounds, touch, lights,
pictures, and smells either for a calming effect on
agitated patients or to stimulate patients who have
withdrawn. The concept was first dreamed up by a couple
of Dutch scientists, Jan Hulsegge and Ad Verheul --
'snoezelen' is a contraction of the Dutch words for
'sniffing' and 'dozing' -- in the seventies. They first
noticed the positive effects in adults with mental disabilities.
The idea spread like wildfire
in Europe, but it's taken much longer to catch on in
North America. But mostly thanks to word of mouth and
grassroots organization there are now over 400 such
rooms in Canada, roughly half of them for demented patients.
Barbara McCormack is largely responsible. She heard
about the treatment and went to England in 1991 with
her daughter, a Aicardi Syndrome sufferer, to check
it out. Her daughter, who was blind and severely disabled,
showed some animation for the first time in her life.
Ms McCormack immediately set about bringing snoezelen
to Canada. She's now the Vice-President of Flaghouse,
the company that markets the product in North America.
Twelve years on and she's
as enthusiastic about snoezelen as ever. She emphasizes
that the reason the therapy works is that it's tailored
to the patient's needs. "There's no formula -- my moods
and yours are different," she says, speaking from her
office in Toronto. "Communication is a big part of treatment.
A picture will dawn of what the client likes."
"There are quite a degree
of dementias, from aggressive Alzheimer's to the later
stages of dementia where they're totally withdrawn,"
says Ms McCormack. "We use different combinations, of
projectors for example, for different degrees of impairment
-- we use different music or aromas, depending on what
sort of sensory stimulation the person needs."
There's a catch, of course.
The rooms are expensive to set up. The average room
costs about $25,000, but costs can as high as $80,000
for all the bells and whistles. A starter kit with bubble
tube, tactile quilts, fibre optic lights, and music
costs about $7,000.
DOES IT WORK?
One of the reasons
the idea has been slow to gain acceptance in Canada
is the lack of rigorous clinical data supporting the
anecdotal evidence. A recent systematic review of snoezelen
research observes that "the clinical application of
snoezelen often varies in form, nature, principles and
procedures. Such variations not only make examinations
of the therapeutic values of snoezelen difficult, but
also impede the clinical development of snoezelen in
dementia care." One recent study, published in the Journal
of Advanced Nursing, concluded that multi-sensory stimulation
is "no more effective than an activity in changing the
behaviour, mood or cognition of patients with dementia
in the short- or long-term." It appears that while the
therapy seems to work in the here and now, the positive
effects appear to deteriorate after the sessions ended.
That hasn't stopped the brand
new Moe Levin Centre Dementia Unit at the Douglas Hospital
in Montreal from putting in a snoezelen room for their
patients. Their experts aren't troubled by the lack
of evidence supporting the rooms, and in fact relish
the challenge. "We have to be at the forefront and test
approaches that are new," says Dr Hildegard Brack, one
of the lead researchers in the unit.
But so far she feels the
investment's been worth it. She recalls a session with
one patient who was very nervous, like many people with
dementia. "She's still at the stage where she comprehends
and expresses herself very well," she says. "During
the session, she was able to tell me how her level of
nervousness was. Within 15 to 20 minutes she had calmed
The effects don't seem to
last, though. "In the short-term she was calm, but it
only continues a little bit after," says Dr Brack. No
one knows yet about the long-term effects yet. "We're
planning to do research that is more organized and structured."
ON THE FRONT LINES
Despite this, Canadian
facilities for demented or Alzheimer's patients are
signing up for snoezelen like fury. "We're seeing the
numbers grow," says Ms McCormack. "Now we're setting
up about half a dozen rooms a month -- this time last
year we were setting up that many in a year."
One nursing home in Ottawa
is absolutely thrilled with their room. "We have one
elderly lady who wasn't speaking at all and wasn't interacting,"
recalls Lori Norris, an administrator at Carlingview
Manor. "Jen attended many snoezelen sessions with her
daughter. During the session she had lots of expression,
she oo-ed and aw-ed. She even had a brief reminiscence
with her daughter and remembered a bit about the past."
Ms Norris says patients and
their families love the snoezelen room. Families can
even book sessions for themselves when they're feeling
There's always a downside
though. The top pick on the music player? Enya.