Dementia Literature Review

PICO framework (Patient / Population, Intervention, Comparison & Outcome) was used to formulate the report question. The PICO components help in identifying relevant information to guide investigations to produce the evidence required in a research (Polgar, 2013). An initial browse was carried out in order to get information on current evidence available and how it relates to clinical practice. Google Scholar and Google search was used in the initial browse using keywords from the PICO question, these words include dementia, music therapy, agitation in dementia, older adults. These provided information around the question area from articles, government policies and charity organisations for dementia. Evidence of this initial browse is provided

A. Jean Ayres. Ayres’ was an occupational therapist that was responsible for the foundation and practice of sensory integration theory (W&S). Sensory integration theory is used to explain behavior, plan intervention, and predict how behavior will change through intervention (Roley et al., 2007). Ayres’ focus was on the organization of the central nervous system and how it was involved in the process of children using sensory information. Ayres’ theory of sensory integration describes how the neurological process relates to the recognition and organization of sensation from the body and environment (Devlin et al., 2010). This disorganization can lead to problems with learning, development, and behavior and also has a negative impact on occupational performance. In relation to the topic of Wilbargers’ DPPT, the focus of the articles collected was related to theoretical research on one particular sensory modulation problem defined by Ayres: tactile defensiveness. Tactile defensiveness is exhibited through the negative influence of touch avoidance symptoms (Moore & Henry, 2002). The aim of the Wilbargers’ DPPT is to utilize the connection between the client’s tactile sensation through the skin and nervous system to improve and normalize the sensation of

In long term care homes in Canada, the Alzheimer Society states that there are more than 500,000 people who have been diagnosed with dementia. (Alzheimer, 2012, p,1) This is a disease that affects one’s brain and is characterized by “changes in the cognitive, psychomotor, emotional and behavioural domains” (Cruz, Marques, Barbosa, Figueiredo, & Sousa, 2011, p.282) of the brain. There has been research done more recently that suggests that a new technology called multi-sensory therapy or Snoezelen therapy may be able to maintain or improve some of the remaining abilities in a patient suffering from dementia such as self-care or communication. Multi-sensory, or interchangeably Snoezelen therapy was developed in the 1970’s by therapists working to find treatments for those with mental illness. “Their intention was to provide people who had sensory and learning disabilities the opportunity for relaxation and leisure experience.” (Burns, Cox, & Plant, 2000, p.120) The concept of Snoezelen aims to stimulate senses without the need for one to take part in intellectual activity. It also offers patients a ‘failure-free’ approach suggesting that there is no pressure to achieve or succeed. (Burns, et al., 2000, p. 120) To stimulate the senses, Snoezelen uses mixtures of light, smells, taste, and touch accessed through one’s sensory organs being the mouth, nose, eyes, ears, and skin. With the introduction of Snoezelen into the realm of long-term care and dementia, the aim is to

“Sensory processing, (sometimes referred to as “sensory integration” or SI) is a term that describes the way the nervous system receives messages from the senses, and turns them into appropriate motor and behavioral responses,” (“Sensory processing disorder foundation,” 2014). No matter the task we are fulfilling: eating lunch, sitting in a classroom, or walking around at the mall, there is some type of sensation involved. Be it the taste of our food, the sound of people walking by, or the bright lights of a classroom, we are surrounded by sensory stimulation. “Sensory Processing Disorder, (SPD) is a condition that exists when sensory signals do not get organized into appropriate responses,” (“Sensory processing disorder foundation,” 2014). Occupational therapist and developmental psychologist, Dr. Anna Jean Ayres (1920-1989), Ph.D., OTR, was the first to use the term sensory integration dysfunction in 1963 and described it as, “The neurological process that organizes sensation from one’s own body and from the environment and makes it possible to use the body effectively within the environment,” (Ayres, 1972). It is sometimes referred to as a neurological “traffic jam” preventing specific parts of the brain from receiving the sufficient information they need to respond to stimulus in the environment.

Claire (OT) provided Zelna and Stanley, Jean-Louis’s parents with the Sensory Profile caregiver questionnaire to complete in their own time and Zelna has returned for marking prior to appointment. Sensory processing is our ability to determine a range of sensory information such as sight, sound, smell, movement and touch within the brain. Sometimes one or more of the senses may be under or over reactive to stimulation/sensation and thus a child may be under or over aroused. For learning, it is important to be in an optimum state of arousal. The Sensory Profile is a caregiver questionnaire that contains statements about children’s responses to sensory events in daily life.

Sensory Deprivation experiments have been around since the early 1900 's. People have always curious to know what happens if you take away the five essential human senses. Our senses help us make sense of in the insane, fast paced, stressed world we live in. Not having one of our senses can lead to the process of learning how to live comfortably without that certain input of senses. While having none of the senses can lead to creating your own world by hallucinating. Without having any of the senses, can you get in contact with the supernatural? One experiment suggests that it is possible depending on the person. Is it possible that depriving all of the senses from a person could be relaxing to some? Yes, having a break from the world can help relieve stress. What happens if you just take away one of the main senses from a human? It can lead to fully understanding how lucky we are to experience the world with each of our senses.

Occupational Therapist, Jessica Crowe, states, “Data analysis revealed that there is no evidence supporting the effectiveness of MSE interventions for those with dementia” (p. 200). Crowe based this statement off of results of a systematic review conducted in 2002. This review was made to determine the effectiveness of MSE interventions for individuals with dementia consisting of three sessions showing no significant changes in behavior, mood, or cognition immediately after sessions, at mid-, post-, or one-month post intervention follow-up" (Chung & Lai, 2002). Crowe states, “These findings should be viewed with caution due to the wide variety of studies included in the analysis and limited rigor in the approach” (2014). Because the complexity and individuality of reactions to the sensory stimulation, “MSE interventions are difficult to measure

Aromatherapy is an increasingly popular alternative therapy for treating Alzheimer's and dementia. Studies are showing that sensory stimulation can decrease agitation and help improve mood, appetite and overall quality of life. Essential oils are typically used when using aromatherapy. The most common essential oils used in the treatment of Alzheimer's and dementia are lavender, lemon balm, peppermint, rosemary, orange, bergamot, and ylang ylang. Lavender, lemon balm and peppermint have been shown to have to have calming and relaxing effects. One study from the United Kingdom made note of the marked decrease in disturbed behavior they were seeing from dementia patients when a combination of essential oils were used. This led to reduced

While we are students, learning to become occupational therapists, we are often going to come across a condition that we are unaware of and want to learn more about. For us, we came across Sensory Processing Disorder (SPD), and did not know much about it. We understood that SPD had an impact on a child’s ability to take in sensory information and affect how his or her brain reacts to it. However, we did not know how it affected a child in their day-to-day living, so we developed a clinical question of ‘how does sensory processing disorder affected children in their everyday life?’

A therapy program targeted to adults 21 years and older, the Sensory Program focuses on sensory integration, rehabilitation, and quality of life (Aptus Treatment Centre, 2016). Sensory integration is the process of absorbing sensory information followed by organizing and assigning meaning to said information, and thus, making it worthwhile (Aptus Treatment Centre, 2016). To respond appropriately and effectively to given sensory input and/or a situation, one experience appropriate sensory integration (Aptus Treatment Centre, 2016). The cliental of Aptus impairments in the way they integrate, process, and organize sensory information, resulting in feelings of confusion, stress and anxiety, frustration and fear (Aptus Treatment Centre, 2016). Thus, the goal of the sensory program is to reduce feels of anxiety, develop coping strategies, and offer opportunities in which to learn self-regulation and self-expression (Aptus Treatment Centre, 2016). As such clients participate in activities such as a period within the “Snoezelen Room,” “relaxation time” and “music” (Aptus Treatment Centre, 2016). The “Snoezelen Room” is an artificially designed space that offers a relaxing environment through soothing lighting, music, gentle vibrations, and tactile sensations (Aptus Treatment Centre, 2016).

Jean Ayres an occupational therapist, developed the theory of sensory integration in 1960 (Smith, S., Mailloux, Z., & Erwin, B. n.d.). Jean Ayres defined sensory integration as “The neurological process that organizes sensations from one’s body and from the environment and makes it possible to use the body effectively in the environment” (Ayres,1989, p. 22). Occupational therapists are trained in adapting the environment to address such individual client needs (What Is Occupational Therapy, (n.d.). Jean Ayres believed that the various sensory systems allow us to successfully interact with the environment (Ayres, 1972, p. 1). Moreover, additional research also suggests that a child requires appropriate levels of arousal, orientation, and attention in order to interact and engage with the environment (Case-Smith & Bryan, 1999).

The debate surrounding sensory processing disorder or sensory integration disorder is not a new but is growing within the medical and education fields. Many feel that sensory processing disorder is just the next “it” diagnosis. Others feel that sensory processing disorder is a real and effects many children. Research surrounding sensory processing disorder by itself is limited. Often, the research involving sensory processing is conducted with other disabilities or illnesses. The issues surrounding sensory processing disorder are:

Current sensory integration theory proposes that a very wide array of difficulties and maladaptive behaviors can derive from disordered sensory processing. Sensory Processing Disorders are further categorized as issues of hypersensitivity, hyposensitivity, and sensory discrimination. These disturbances of processing are recognized as potentially occurring in any sensory modality, be it visual, auditory, olfactory, tactile, gustatory, proprioceptive, or other interceptive

Two alternatives used to treat symptoms of AD are massage therapy and aromatherapy. The effect of these treatments are considered calming to a patient that may be hostile due to loss of cognition. Not many scientific studies have been conducted on how massage therapy and aromatherapy are beneficial to treating AD patients. There is need for more studies due to the ever changing nature of understanding massage therapy. There seems to be positive results for treating patients in agitated states using stand alone or combined alternative treatments.

Future research is needed in the areas of prevention, assessment, and intervention. A greatly structured research project is needed for determining how to prevent or slow dementia. For assessment, establishing multi-disciplinary teams willing to share their knowledge of cognition and hearing is critical. More research is needed for intervention to determine the burden that is placed on a caregiver, as well as how intervention could assist caregivers faced with taking care of an oldest old patient with a hearing loss and dementia.