Application of Sensory Integration Therapy to the Geriatric Population:
An Experience Sharing on Reducing Unexplained Problematic Behaviors
in People with Neurological Disorders
感觉统合治疗于长者康复的应用: 减低脑神经科患者问题行为
之临床经验分享
TAM Hiu Yan, Janette 谭晓茵
CHAN Yan Chi, Samuel 陈恩赐
Occupational Therapists 作业治疗师
2012 International OT Conference 2012国际作业治疗研讨会
26/02/2012
My Heavenly Father
For HIS creation, gift of life & inspiration For HIS complete supply
“In the beginning God created
the heaven and the earth.” Genesis 1:1
“The unfolding of thy words gives light;
it imparts understanding to the simple.” Psalms 19:130
Haven of Hope Christian Service Operation Santa Claus
Thanks!
Acknowledgement
Content
• Background • Interventions• Results & Case Studies
• Discussions
• Conclusions
• Nursing home
• 58 elderly (stayed 3 months or above)
• 90% Aged 75+ (Mean: 82.83 years old)
• 91% Moderately to severely dependent
Mean Barthel Index Score: 34.93/100 (Severe)
• 53% with 1 or more unexplained problematic behaviors
Background
“Unexplained Problematic Behaviors”
• Abnormal qualitative or quantitative deviance
• Likely to affect physical safety of the person or others
• Cause significant distress to the person or others
• Significantly add impairment
• Likely to seriously limit or delay access to and use of ordinary community facilities
(Einfeld & Aman, 1995; Emerson, 1987)
“Unexplained Problematic Behaviors”
Influences:
• Staff:
–Difficulties in personal Care –Injury-on-duty
• Elderly:
–Additional medications –Artificial restrictions –Further isolations
• Poor human environment
“Unexplained Problematic Behaviors”
(After ruling out organic & psychosocial causes)
• Withdrawals, e.g. refusal of meals, Lack of responses,
Soullessness, depressed
• Aggressive behaviors, e.g. fight-backs, yelling
• ?Self-stimulation
e.g. eating / painting excretions, tearing diapers
• etc
• Sensory Integration is a theory & concept initially developed by Dr. A. Jean Ayres, PhD, OTR, since early 1970’s • A Neurological process Feedbacks Sensory Input Sensory Integration (Register, modulate & process) Adaptive Responses
Re-understanding Elderly
“Unexplained Problematic Behaviors”
(Miller 2007)
Re-understanding Elderly
“Unexplained Problematic Behaviors”
• graph
Re-understanding
Brain Viscous Cycle in Frail Elderly
(Diagram)
- Decreased ability to receive environmental info thro’ senses - Troubles processing & integrating the info - Inability to plan and execute
“New” Definition
• Unexplained Problematic behaviors could be
a presentation of
Sensory Processing Disorder
(also known as Sensory Integration Dysfunction)
(Refers to the inability of the central nervous system to perform effective S.I.)
Interventions
• Experience Sharing:–12 Nursing home residents –7 female, 5 male
–Aged 75+
–Suffered from 1 or more neurological disorder(s) –Joined rehab and/or routine
services < 3 months –1 or more non-organic
problematic behavior(s)
Interventions
• Experience Sharing: • Deranged Sensory Profile• level 2/7 (mean) in Ayres’ 7 Levels of
Adaptive Responses (Data)
(= Norm of 65+ years old + 1 S.D. more than norm - 1 S.D. less than norm)
Interventions
• Individual Sensory Integration therapy x 10-15 sessions • Sensory diet in daily routine with regular review • Usual programs continued
• Review after 1 year • (Diagram of Practice Model)
• (Despite 2 missing data due to medical issues)
• Similar results in sensory profile with a trend towards norm
• Slight increase in B.I. scores (functional independence)
• Significant reduction in unfavorable behaviors
• Significant increase in adaptive responses
• Increased self-expression, participation & interaction with fellow staff, carers & the
Results
Results
Cases Studies - LLS
• F/73
• Dx: Lt. MCA infarct w/ post CVA epilepsy Bil. Cerebral infarcts (Lt. total anterior Rt.
partial circulation infarct, large intracranial artery atherosclerosis)
• Other MHx: HT, DM, CHF, GI bleed & anemia, bil. Chronic frontal subdural haematoma, cerebral atrophy, Rt. knee degenerative changes, cataract, tinea pedalis
• Pre-mobid: ADL indep, owner of a small resturant
• O/E:
• ADL dep. (B.I. 1/100; MMSE: N/A), R/T feeding • Strongly refusal of diet, drooling+
• Nil vocalization, nil localization to sound • Rt. visual neglect; Active control of Rt. U/L • Response to passive stimuli
• (Sensory Profile data)
Cases Studies - LLS
–Classical S.I. once a week x 10 sessions
–Consultative S.I. interventions added during routine rehab session (3 / week)
•Therapeutic listening during APT & passive standing
•Vibrations on joints
•Aroma massage
•Sensory diet carried our by daughter
–Oral feeding, massage
Cases Studies - LLS
Progress
• Increase alertness & awareness to environment • Simple conversations
• Demonstrated localization of sound w/ eye contact & head turning
• Drooling decreased
• Tolerate routine oral feeding (100ml) (x2 / day) • Discharged to C&A Home
• (Sensory Profile Data)
Cases Studies - LLS
• Video It appears that S.I. therapy is…
• Effective in modifying elderly “unexplained problematic behaviors
• Improving their awareness & interaction with the environment
Treating sensory integrative dysfunction / sensory processing disorder in the geriatric population may be the missing pre-requisite of re-engaging frail elderly into daily living.
1. Acknowledge the importance of sensory integration functions in frail old-olds
• Essential function towards connection & responses
• STOP! Vicious cycle of “mal-nutrition” of the
brain
–Decreased sensory-seeking behaviors –Decreased sensory-processing ability
Discussions & Conclusions
2. Trans-disciplinary approach for Sensory Diet
*Unified Handling, Management & Routine*
Discussions & Conclusions
3. Interventions needs for strengthening individual S.I. functions
• Need of prevention,
early detections & interventions to potential S.I. dysfunction
Discussions & Conclusions
4. Manage external sensory environment
–Creates CNS friendly environment
–Avoid confusions of sensory input in routine –E.g. Ensure enough lights during daytime
Discussions & Conclusions
5. Need of further research - Model of Practice - Risk management
- Evaluation tools
*Sensations are the drugs & food of the brain Use Wisely!
Thank You!
Further discussion is welcome:
“Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day.” (II Co4:16)
