Israel is among the leaders in implementing a Dutch idea using controlled stimulation.
By JUDY SIEGEL-ITZKOVICHPhysio 298.88(photo credit: Judy Siegel-Izkovich)
Soft music, a waterbed, glass tubes with bubbles rising, pleasant odors, spotlights, vibrating cushions, furry stuffed animals and revolving globes with mirror tiles will probably not cure anything. But controlled stimulation of the five senses in Snoezelen rooms while not regarded officially as a therapy has been shown to benefit the mentally and physically disabled, from babies and toddlers to the demented elderly.
The term is a contraction of two Dutch words meaning "sniffing" and "dozing" and was first developed in Europe three decades ago. Britain alone has over 1,000 Snoezelen rooms, according to Rompa, the company that owns the Snoezelen trademark. The technique, which is not widely used in the US, has become very popular among occupational therapists and other professionals in Australia, Germany, Malaysia, Switzerland and Israel, among other countries.
Controlled multisensory stimulation was first introduced here in 1993 at Beit Issie Shapiro, a non-profit community organization in Ra'anana that provides a variety of services for children with developmental disabilities and their families. Not too long ago, it held the country's first conference on Snoezelen rooms; over five days, it attracted 360 participants who listened to the delivery of 20 papers by Israeli and foreign professionals.
Israel is considered among the world's leaders in the use of such rooms. The lecturers reported that Snoezelen is helpful in treating children living under stress, terror victims, children suffering from pain and anxiety after burns, head injury victims, families of children with severe disabilities, victims of cerebral palsy and gravitational insecurity, demented patients and it even alleviates stress in dental patients. Although people with autism are said to suffer from "overstimulation," controlled sensory stimulation has been shown to bring improvement in some of them.
Various institutions, including Beit Issie Shapiro and Jerusalem's Shaare Zedek Medical Center, offer courses for preparing and using sensory stimulation rooms. The capital s first Snoezelen room was built at Shalva, the Jerusalem-based Association for Mentally and Physically Challenged Children in Israel, while others have followed at the Kfar Shaul Mental Health Center, the Siah Sod center for mentally disabled children and other public or non-profit institutions. Now Herzog Hospital, a leading geriatric and psycho-geriatric facility in Jerusalem, has installed a new Snoezelen room, this time for rehabilitation of a wide variety of patients, most of them elderly but also some children. To mark the event earlier this month, the hospital showed it off and asked some of its professionals to describe their work in it during the past few months.
Hospital director Dr. Yechezkel Caine said he hoped the new facility which cost several tens of thousands of dollars, including construction costs would "improve the abilities of patients suffering from mental, psychological, cognitive, movement and other patients even the comatose and those attached to respirators. We have some people who have been attached to a ventilator for a long time, even children and infants. The longest period is seven years. All of them could benefit from the Snoezelen room."
Herzog s cozy room, with a soft carpet, comfortable chairs, fiber-optic colored lights, stereophonic sound and other amenities was financed by Lloyd Cohen from Winnipeg, Canada, in memory of his parents Berdie and Irvin, the foreign donor's first major contribution to the hospital. The actual construction work and equipping was done by businessman Moshe Shalev, who underwent training for preparing Snoezelen rooms.
This specially designed treatment room provides an environment consisting of a variety of carefully selected elements, such as the fabrics and textures lining the walls and ceiling; a calming white, a bubble pillar provide visual stimulation and a sense of vibration, soft music and scented air all contribute to enhancing recovery. All these elements stimulate the senses of vision, hearing, touch, taste and smell. The room is unique in that it provides optimal conditions for the creation of personal relationship with a patient, and improves his sensory balance. Operation of the equipment can be controlled by quantity, type and level of stimulation.
Patients in the departments of Psychiatry and Treatment-Resistant Depression, as well as children coping with ADHD can also be helped by being treated in the Snoezlen room.
Herzog occupational therapy chief Ronit Levy said that treatment room provides an environment consisting of a variety of carefully selected
elements that stimulate the senses of vision, hearing, touch, taste and smell. The fabrics, furry toy dog and textures lining the walls and ceilings appeal to the sense of touch; the bubble pillar provides visual stimulation and a sense of vibration; the soft music and scented air all contribute to enhancing recovery. It provides optimal conditions, she said, for the creation of personal relationship with a patient and improves his sensory balance. Operation of the equipment can be controlled by quantity, type and level of stimulation. Patients in the departments of psychiatry and treatment-resistant depression, as well as children coping with attention deficit hyperactivity disorder can also be helped by the Snoezlen
room, she added.
Demented patients, for example, do nothing most of the day and constantly want to get attention and stimulation. Since none of them has round-the-clock personal care, they often display disquiet and disruptive behavior to get attention. Being brought into the Snoezelen room with an occupational or physical therapist for 20 minutes per session can, said Levy, advance their well being, make them calmer and improve the relationship with their therapist, who "flows with the patient rather than following a rigid plan."
Patients don t have to be able to speak or have motor abilities to benefit from the sensory stimulation, noted Levy, who three years ago was the one who suggested a Snoezelen room to hospital director Caine. "They don t have to 'learn' or 'do' anything specific." The session relieves boredom and empowers the patient if he or she is able to express a preference for which elements to use.
Levy explained that the Snoezelen room should be suited for its users. If comatose or otherwise respirated patients are brought in, oxygen-supply points can be installed. Parquet floors are easier to clean, for example, but they could be slippery for some. Certain patients may be scared of the dark, so lighting should be adjustable, with the patient able to control the dimmer switch. A ball of mirror segments such as those that hang in discotheques have been found to make some patients, especially the elderly, dizzy, she said. Rocking chairs may be welcomed by some patients but not others. Classical music could calm one patient, but a demented person hearing it could become upset by being unable to remember its title or who composed it.
Levy said that all patients, whatever their age, undergo pre assessments before being considered for the Snoezelen room, and afterward, their reactions and any visible improvements are noted. No one is forced to do anything in the room. "If the patient wants to sit on a rocker for 20 minutes, he can do it if he likes."
Sharon, an occupational therapist in Herzog s complex nursing department, described the case of a 70-year-old, Israeli-born grandmother who suffered a stroke and became paralyzed on the right side of her body. "She doesn t speak, doesn t have sensations on the one side and makes aggressive head movements. It s difficult to treat her and catch her attention." After undergoing sensory stimulation in the room, Sharon reported, the woman became more relaxed, enjoyed relief from her pain, listened to music and took initiative. Family members learned to join in and sang to her during the sessions. Sharon said she regarded the Snoezelen room as "an additional therapeutic tool that can improve patients' conditions."
Movement therapist Haya Goren described her work with a five-year-old girl, named 'Y,' who had been severely injured in an accident two years before and since then has lived in a Herzog ward. "She is paraplegic and it isn t certain if she can see, but her eyelids cannot close so we have to cover her lovely blue eyes from time to time to prevent harm to them. But she s a beautiful, sweet-looking girl, wearing fashionable clothing."
Before Y was wheeled into her first session, she underwent preparation (such as suction of her throat) in the ward, where she is used to hearing radio noise. Tapes of children s songs and soft background music were played in the Snoezelen room, and her arm and leg braces, shoes, socks and eye covering were removed. Goren said she massaged her neck and limbs skin with lavender-scented cream to relax her and reduce spasticity.
"I kissed her and treated her as if she were a normal child. I felt she was looking at me. I brought her the furry dog doll and a light stick. She moved her head and grabbed my hand. I m not sure it was a reflex or intentional, but I think her reactions were much better in the Snoezelen room. Her mother joined the session and was so pleased; she thanked me with tears in her eyes and asked: 'Could I get such treatment too?' I tell all the parents: Never give up. There is always hope."
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