JANUARY 30, 2004

Have you ever snoezelened?

Multi-sensory stimulation rooms are popping
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touch, lights, pictures, and smells either for a calming effect on agitated patients or to stimulate patients who have withdrawn.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are quite a degree of dementias, from aggressive Alzheimer's to the later stages of dementia where they're totally withdrawn," says Ms McCormack.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.

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 down."

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."

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 stressed.

There's always a downside though. The top pick on the music player? Enya.



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