The OT’s Perspective: Sensory Loss – A brief overview
As occupational therapists, we help a lot of different people in a lot of different ways.
But one of the things we perhaps don’t talk about enough is sensory loss.
There are multiple reasons for clients to lose senses, and the implications for their quality of life can be significant – it’s for that reason that a big part of occupational therapy for those who’ve lost full sense capability is to mitigate those results as best we can.
First things first, what is sensory loss?
Sensory loss may include abnormal sensation, decreased perception and awareness of the body and decreased coordination.
What types of sensory loss are there?
Phantom Limb Syndrome
This occurs after having an arm or leg amputated. The client may not be able to process what has happened, leading to them still feeling as though their limb is in place, but is in severe pain.
One way to improve phantom limb syndrome is to reduce the hypersensitivity of it (there are typically lots of nerve endings at the point of amputation, which results in the unpleasant sensation). This can be done by agitating the nerve endings, using gentle touch, towel rubbing, pencil eraser taps or friction massage, gradually increasing touch tolerance, pressure and tactile stimulation.
Children with development delays are particularly prone to hypersensitivity disorders, as well as those with brain injuries. These disorders manifest themselves in sharp “pins and needles” type pain which can be so significant that it debilitates.
Once again, by stroking the area, it’s possible to reduce the nerve’s reaction and the pain as a result.
At the other end of the spectrum some clients experience poor or absent sensation. This comes with significant risk – a client can injure a limb without knowing. Once again, there are treatments that use vibration and stimulation to that limb, in order to rejuvenate any affected areas of the brain and improve the sensation.
So, stimulation can improve sensation. What next?
Once a client’s stimulation begins to normalise, a therapist will start introducing more functional sensation activities.
For example, a small item like a penny or paperclip will be dropped into a bucket of rice, and the client will be asked to retrieve them. This forces the client to use sensation to differentiate between different surfaces, fine-tuning their sensation.
Multi-sensory environments are interactive spaces that offer clients a range of activities to engage with, typically to help their sensory, cognitive and motor skill levels. These environments can be used to help clinicians assess and identify clients’ strengths and weaknesses; identifying need and determining suitable interventions.
The activities within these environments can be graded up or graded down according to need.
For example, if a client is mildly visually impaired and enjoys tactile input and a colour, but a therapeutic goal is to work on improving the range of motion on an upper limb or fine motor skills, one might consider selecting a ball bubble tube with large coloured balls that float gently up and down so the client can see the movement. The activity could be to get them to touch the ball tube, set to their favourite colour and then ask them to reach and touch (maybe count) the balls as they float upwards or downwards.
Examples of multi-sensory equipment
Visual stimulation (Sight) – Optic fibre spray, Projector with reminiscence images, Bubble tube.
Auditory stimulation (Sound) – Relaxation tapes, vibration noise from equipment, wind chimes, music.
Olfactory (Smell) – aromatherapy, perfumes and aftershaves that are familiar.
Gustatory (Taste) – Any food substance that provides distinct flavours or texture. People with autism may orientate to flavours and textures. The challenge might be to gently increase that range.
Tactile stimulation (Touch) – Vibrating cushions and mattress, weighted blanket with different textured fabrics.
Proprioceptive and vestibular stimulation (Movement) – Rocking chairs, rocking horses, stretching and reaching.
How do you know which equipment is appropriate?
Before using sensory equipment, it is advisable to carry out an assessment by a trained practitioner.
Some helpful tools
- The Sensory Assessment and Profiling Tool (Collier, 2003) – identifies sensory preference
- The Sensory Profile (Dunn, 1999) – identifies correct stimulation levels
- The Pool Activity Level (PAL) Instrument for Occupational Profiling (Pool, 2011) –gives guidance on how to run a session for autistic adults
- Multisensory environments information sheets (Pagliano, 2001) – help monitor progress in the Snoezelen environment, recording behavioural responses in a standardised manner.
Some helpful products and manufacturers
Some useful courses and training