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by Debbie Hommel, BA, CRA, ACC, Executive Director of DH Special Services.
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Introducing Interdisciplinary Sensory Approaches
By Debbie Hommel, ACC

Residents with severe cognitive and physical impairments need individualized, ongoing
and appropriate sensory approaches, cues and environments.  “How much is enough?”
is a common question.   The magic time frame of 15 minute visits – three times a week –
is often quoted. For some residents – a visit of 15 minute duration is too long, for others
three times a week is not enough.   Many activity departments barely have enough
staffing to conduct group programs, let alone daily visits with the frail resident.  

We need to remind ourselves of a couple of key points as we work toward developing an
appropriate program for the very frail, potentially isolated resident.   From an
assessment perspective, we need to remind ourselves that each resident has different
needs.  Through the assessment, we can define specific needs for 1-1 programming,
stimulation and solace.  The timing, frequency and content of approach can be
developed through individualized assessments.  

Secondly, from a programming perspective – let’s not forget that everyone needs a
balance of active and passive stimulation throughout their day and week.  Through the
care planning process, specific approaches can be defined and communicated.

Finally, it is a team responsibility to meet the on-going and daily quality of life needs of
the resident.  The activity professional may schedule formal visits several times per
week, however throughout the remainder of the week and when the activity staff are not
present – the team also needs to ensure appropriate forms of stimulation are in place.  
By the team, we mean the Nurse, the Nursing Assistant, the Social Worker, as well any
other person who may come in contact with the resident.  The activity professional can
create the plan, define what is appropriate, obtain the materials, make the materials
available and in-service the team as to how to use the materials.   With the team’s
commitment, the daily needs of the very frail resident would be suitably met.  

The following is a list of suggestions for staff techniques which could be shared with any
staff that provide 1-1 contact with the very impaired resident or sensory programming.  
How to approach the resident, using available materials and making the most of every
interaction could be topics for an in-service.

* Prior to starting the visit or process, verbally greet the resident and let them know what
is about to happen.  Even if the resident is very cognitively impaired, they should be
informed of what is about to occur.    A tactile greeting can accompany the verbal

*When presenting any sensory cues, they should be presented one at a time, allowing
the resident time for processing and response.  Simple verbal cues should accompany
the presentation of the sensory cues, to explain and reinforce what is happening.

*When talking about the cues presented, ask them what the cue reminds them of.  
Refrain from asking questions where there is a right or wrong answer or they have to
correctly identify a cue.  

*Consider the amount of cues and stimulation being presented at one time.  Music can
be used as a compliment to the sensory experience or it can act as extraneous over-
stimulation for the very impaired.  In some cases, quiet is the best compliment to sensory.

*When using touch in a quality of life interaction, rubber gloves are not necessary.  What
contributes to the quality of life interaction is the human-to-human touch.  Infection
control can be maintained through hand washing and antiseptic gels.   

* Be respectful and speak in an adult manner.  Maintaining a calm, soothing,
conversational tone is most effective.  

*Expect a response, even when one may not be forthcoming.  Being aware of small
responses, such as increased eye blinking, increased body movement, ceasing of body
movement, tensing of body/facial expressions (to name a few) is important.

*Let them know you enjoy being with them through your tone of voice and gentle touch.  

*Continually analyze stimulation levels to avoid over stimulation.  We need to create a
balance of active stimulation and passive stimulation.  It is not our goal to constantly
stimulate the resident actively.  For very low functioning residents, five minutes of active
stimulation can be a long period of time.  Be intuitive of the resident's response and if it
seems they have had enough, don't be afraid to stop.  

*We must never forget that each resident is an individual and our approach should be
based on past interests of the resident.       
About Debbie

Debbie Hommel, BA, CRA,
ACC, is the Executive
Director of DH Special
Services. She is a Certified
Activity Consultant on State
and National level, with over
twenty-seven years of
experience in providing
direct care and consultation
to long term care, medical
day care, assisted living,
and ICF/MR facilities
throughout New Jersey,
New York, Maryland, and
Pennsylvania. She is an
experienced trainer and
workshop presenter,
conducting a variety of
seminars throughout the
Tri-State area for the
Activity Professional,
Administrator, and allied
healthcare professional.
Debbie Hommel is an active
member of Activity
Professional Associations
on State and National
levels. She is ACC certified
through the NCCAP. She is
a founding member of the
New Jersey Activity
Professionals' Association,
serving terms as Vice
President and President.
She received the Weidner
Lifetime Achievement
Award in 1994 and the
Monmouth & Ocean County
Activity Professionals Life
Achievement Award in 1999.