Snoezelen, care through the senses

2023-08-22 14:00:40

In the 1970s, two Dutchmen, Ad Verheul, occupational therapist, and Jan Hulsegge, music therapist, took the initiative toan approach oriented towards sensory perception which will be developed under the name snoezelen. This Dutch neologism is a contraction of the verb “snuffelen” (to sniff, sniff, sniff), which introduces the dimension of the person’s contact with their environment, and the verb “doezelen”, which means to doze, to relax. Snoezelen expresses both the notions of sensory stimulation and bodily relaxation.

Fill the void

Faced with the distressing non-existence of occupational activities suitable for people with severe intellectual disabilities, J. Hulsegge and A. Verheul develop, to stimulate them and encourage them to move, materials and concepts (mobiles, musical objects, massages and colorful blankets, elements of nature, etc.). Within the Hartenberg Center, in Ede (Netherlands), in which they work, they are closely interested in the work of American psychologists Cleland and Clark¹ who developed the concept of a “sensory cafeteria” in the United States in 1966 to stimulate the senses of people with mental disabilities.

The Dutch idea focused on two axes: deploy opportunities to develop, promote and encourage communication, and optimize behavioral changes by providing sensory stimulation. It initially concerned people with mental disabilities, or who had developmental delay, an autism spectrum disorder or attention deficit disorder with or without hyperactivity (ADHD). Hulsegge and Verheul welcome their first patients under a marquee where sensory stimulation equipment is installed. Comfort, relaxation, appeasement and relaxation are the key words. Participants had the opportunity to enjoy sensory experiences as well as to relax, by having the choice of their activities or by simply being present in a space where lights, music, smells and various objects created an atmosphere stimulating the five senses.

At the same time, other institutions are testing comparable systems. Their joint reflections led to the first snoezelen-type project in the relaxation department of the Haarendael Center in 1974. The term snoezelen was adopted at a conference in 1979 with the postulate that le snoezelen est “ above all a personal experience, an inner experience “².

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Who is snoezelen for?

Originally designed to support disabled people, following its recognition in France in 1992 by the medical profession, the snoezelen saw its fields of application multiply: gerontology, psychiatry, early childhood, rehabilitation and business environment (focused on stress management). In recent years, in major cities in France, places have emerged where therapists, parents, caregivers and anyone interested in this approach can rent snoezelen rooms by the hour and be accompanied by a professional. Some individuals offer to arrange spaces at home…

Immersion and terre snoezelen

The snoezelen approach is first of all precise equipment: a room organized in several distinct spaces designed to stimulate the five senses (hearing, smell, sight, touch and taste). Each space adapts to the installation location and the type of project (institutional or private). The ideal is to have three distinct but adjacent spaces, away from external disturbances. White adorns relaxation rooms, black those for visual stimulation, brighter colors are reserved for stimulating rooms. Floors, walls and ceilings are covered with different materials such as fabrics, carpets, drapes, to encourage tactile and visual explorations. Arrangements such as water and/or air mattresses, bubble columns, wire walls, foam mattresses, vibrating cushions, tactile panels made up of various textures (soft, hard, rough, smooth, soft, prickly, etc.) , luminous optical fibers, light and landscape projectors (shadow, light and darkness), mirror games, music and sound instruments (rhythm, tempo, relaxation), aroma and essential oil diffusers, smell boxes, foods to taste (salty, sweet, bitter, tangy, spicy, etc.) are arranged in these different rooms.

Sensoriality, mediator of the relationship with others and with the world

The equipment and scenarios are very important to make the space welcoming, warm, soft and conducive to sensory and bodily experiences. This space must also and above all promote relationships with others. The sessions take place in the presence of a trained support person whose presence maintains a feeling of physical and psychological security. No precise objective is defined, only one intention is set: to use sensoriality to enter into a relationship. As stated Christelle Martegoutes, Snoezelen Approach Trainer, “ only the intentions of the sessions count: to connect with, to promote the calming relationship, the participatory exchange, to revalue, to reduce anxiety and/or passivity and/or agitation, to potentiate motor and cognitive capacities and to collect informations “.

Attention is paid to the way in which the person reacts, to their desires, their needs and what sensory experiences bring out. The different stimulations are provided randomly, regardless of the concentration and intellectual level of the patients, so that they can freely experience the sources of sensory stimulation offered.

But the snoezelen is not used “ only for recreational purposes “, warns Christelle Martegoutes: “ This approach is much more than that! ” So, “ the objectives are to become aware of bodily awakening as a source of self-evaluation, to develop a practice of communication, animation and care, and to support, through relaxation, exploration and discovery. The system and the qualities of the companions allow appropriate sensory stimulation, respect for the person and their rhythms, kindness, relaxation and reduction of tension, a feeling of well-being “.

The investment in a snoezelen device is expensive. Without a project and/or without trained and available professionals, the rooms are underused or even set aside³. We have observed this several times in our search for testimonials from professionals in establishments equipped… Many nursing homes have informed us of the non-activity of these spaces due to lack of staff.

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Accompanying cannot be improvised

The trainer Christelle Martegoutes specifies that “the training of the guides is decisive and must be part of an establishment project. The guide must want to get involved, take the time, be available, patient, relaxed, attentive to the setting, attentive, modulate their voice and behavior (stay in the visual field, have a listening attitude , verbalize or not…), propose without being in the action, maintain visual and/or tactile contact, show imagination and creation and keep your right place. Its positioning is decisive for the smooth running of the sessions. The five senses are modes of access to the world, they allow us to capture information, are tools for memorization and communication and are generators of emotions essential to a social and emotional life and to cognitive mechanisms. ».

Progress of a session

The session takes place in several stages, “acclimatization” or preparation for entering the room, “the invitation and the entertainment”, which is individual, non-directive support, which lets the person enjoy the environment. Thirdly, the guide warns the person of the “end of session” and a gentle return to reality. The phase of “reappropriation and evaluation ” concerns the analysis and taking notes on an evaluation grid in order to follow developments from one session to another. The last step is that of “disinfection of equipment “. The session lasts between twenty and forty-five minutes depending on the person welcomed.

Benefits documented by science?

In older people with behavioral disorders or Alzheimer’s diseasea decrease in aggressive behavior, pain and apathy, blood pressure and heart rate were observed immediately following the snoezelen sessions. A significant increase in self-esteem up to one week following the end of the sessions was noted. A reduction in behavioral disorders (agitation, verbal and/or physical aggression and anxiety in elderly people with acute cognitive disorders) has also been demonstrated. Sensory stimulation performed before washing reduces behavioral problems in elderly people with dementia during care, and this effect persists throughout the day.⁴. Snoezelen allows you to establish a connection through sensations and emotions when the elderly person no longer has access to verbal communication. In his study dissertation⁵ on the snoezelen approach in the psychomotor care of elderly people suffering from Alzheimer’s, Chloe Quentin explain that “this space promoted exchange, relationships, sensoriality and well-being; the psycho-corporeal approach through the sensory axis allows a reappropriation of the body through the discovery of new experiences. This bodily experience can awaken sensory and emotional memory, reviving past memories, refocusing the person at the heart of their story. “.

In daycare, snoezelen helps develop the sensoriality of toddlers, improve the management of their emotions and their cognitive development by stimulating all of their senses in a fun, safe and soothing way. This framework brings them peace and helps defuse tensions. These are, continues the psychomotor therapistthe times “of progressive and qualitative discovery, necessary for the child’s psychomotor development ” and moments of special relationships between the child and the carer.

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Snoezelen in hospital

Dupuytren hospital, in Draveil (Essonne), has snoezelen spaces in the UCC-UHR unit which welcomes patients suffering from Alzheimer’s disease and related diseases. Snoezelen completes the range of therapeutic proposals which are beneficial to dementia pathologies manifested by loss of bearings, distortion of perceptions, withdrawal into oneself, difficulties in communicating, aggressiveness, agitation, anxiety, wandering and emotional control problems. The professionals who support these patients observe a reduction in anxiety and behavioral disorders, better bodily relaxation and better relaxation. Snoezelen thus offers the patient another mode of communication and allows him to enter into relationships with others and his environment.

A reduction in problems

The use of snoezelen spaces also seems to give encouraging results in care for autistic people. A reduction in stress was observed with a better understanding of the environment, easier communication, help in knowing body limits and in exercising fine motor skills. The spaces are suitable for developing skills such as object persistence and cause and effect relationships, which are important stages in child development. If the results of the studies carried out by psychologists and researchers P. Martin and J.-L. Adrien with autistic adults are not statistically significant, they observe that they are “at certain times, more available and more open to provide sensory awakening work. The material available in the snoezelen environment seems to be sufficiently effective in initiating and strengthening the attention of people who present with autistic disorders and associated mental retardation. “⁶. A study published in 2017 on the support of adults with autism spectrum disorders and profound intellectual disabilities concludes that the people followed “show better investment in the activities offered, an increase in autonomy and a reduction in self-stimulation within the snoezelen room “⁷. In 2021, another study presents multisensory environments beneficial for the behavior, attention and mood of children with autism⁸.

An article from Pascal Martin in the French-speaking Review of Intellectual Disability in 2015 takes stock of studies carried out around the world onhe positive effects of snoezelen environments on dependent people in institutions. If certain studies fail on methodological aspects and/or with statistically insignificant results, the author notes “that emotional regulation is observed. And it seems that a relationship between sensory stimulation and the reduction of behavioral disorders has been established. In any case, snoezelen seems to favor […] psychological appeasement, while providing individuals with a state of well-being “. La For Patricia Schofield has carried out more surprising studies regarding effects of snoezelen on chronic pain. In 2002, his results suggested that snoezelen environments are at least as effective as relaxation teaching in the traditional pain clinic environment for this group of patients.⁹.

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What do we think on the ground?

Bénédicte Casenove, medical-psychological help in a service for children with multiple disabilities at the Romagnat Children’s Medical Center (Puy-de-Dôme), gives us some impressions of his snoezelen experience over the past eight years. “We mainly use these rooms for children whose disabilities are such that they are unable to do other activities. These are unique moments, dedicated times for them. I accompany each child once a week for more or less long periods depending on their feelings. We see real improvements, the children feel good in these dedicated times, which encourages us to continue. I sincerely think that snoezelen is very suitable for the children we welcome. The management has chosen to invest in a new, larger room from which more children will soon be able to benefit. »

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