AAMSE ISNA Research Summary, 2010

Christopher Giza, MD


AAMSE Summary Research Report from 8th International Snoezelen Association (ISNA) Symposium sponsored by the Christopher Douglas Hidden Angel Foundation
Birmingham, AL
October 1-3, 2010
Below is a scientific summary of some of the sessions at the ISNA meeting earlier this month in Alabama. This summary is from Doctor Chris Giza; “I have only included sessions that I individually attended or received a summary from another attendee.” The full conference program is still available on the web at http://www.isna2010.org/ConferenceProgram.html.
Keynote Speakers:
David Dobbs gave an informative lecture about epigenetics – the interaction between gene expression and environmental stimuli. He used several examples of genes that could pre-dispose to certain conditions, including his own personal
experiences. Emphasis was placed on the fact that while genotype could influence an individual’s behavior and cognition, these associations were still malleable, and that genes identified as risk factors for medical or behavioral conditions (such as depression, anxiety, etc.) might also predispose to other advantageous qualities (such as creativity, etc.). The area of epigenetics is a very new field and it is valuable for MSE practitioners to be aware of it.
Dr. Jason Staal gave a presentation that addressed the novel use of an MSE in a psychiatric hospital. The transition from Snoezelen to comfort room was addressed. The paradigm shift that has led to the use of comfort rooms to reduce seclusion and restraint was reviewed. The theory and practice of the comfort room was discussed describing changes in conceptualization of the challenged psychiatric patient and the need for seclusion and restraint. Data was presented of the use of a comfort room as a seclusion room was taken offline at a state psychiatric facility in Maine, USA.
Dr. Paul Pagliano discussed the use of MSE in educational settings. Emphasis was placed on determining individual educational needs and then establishing specific and measurable goals for each student/participant. For both education
and potentially for research, baseline performance would be recorded, MSE intervention utilized and then each student’s educational progress would be assessed and monitored.
Dr. Chris Giza provided a translational overview of the substantial basic neuroscience research that supports the use of MSE to promote brain plasticity. Basic concepts of plasticity were introduced, and then specific examples of environmental effects on brain structure and function were illustrated. These include normal developmental changes, maternal behaviors, enriched environment, medication effects and voluntary exercise. In addition, he discussed the use of environmental manipulations to promote recovery after brain injury (alone or in conjunction with pharmacological agents), and the critical importance of the timing of these interventions.
Katie Gaudion presented her insights into new materials for MSE, including the fact that many current MSE products are plastic, excessively expensive and provide little variety in tactile stimulation and texture. As a designer, she has developed a series of inexpensive modifications to props and some unique new props that provide these missing elements without adding inordinate cost.
Dr. Gillian Hotz gave an overview of the relative paucity of evidence-based research on the efficacy of MSE or cognitive enhance after brain injury or developmental disability. She reviewed the idea of stimulus preference assessment and earlier experience with coma arousal therapy. She then gave a detailed description of her randomized controlled trial of MSE for recovery after severe pediatric TBI, including the many challenges faced by trying to conduct clinical research. Important points emphasized include developing measurable and objective outcome measures, and having an appropriate comparison (control) group.
There was an excellent panel discussion on the past and future of Snoezelen therapy that gathered the main proponents and founders of Snoezelen/MSE at the same table at the same time, including Ad Verheul, Jan Hulsegge, Maurits Eijgendaal, Linda Messbauer and Dr. Krista Mertens. Items covered included the underlying philosophy of Snoezelen/MSE, opportunities and challenges in different countries, development of an evidence-base for use of Snoezelen/MSE, policy/advocacy efforts for broader availability of Snoezelen/MSE and views of the future for the field.
Selected Workshops:
Barbara Vartanian shared her extensive experience using MSE in a pediatric mental health setting. She provided practical experience gained in setting up her own rooms, and gave attendees a glimpse of the substantial quality control data
collected by her team. Pediatric specific qualitative assessment scales for mood, anger, anxiety, etc. were also presented. The importance of this data collection was emphasized for improvement of care, better efficiency in care delivery and also for future efficacy research.
Dr. Michele Shapiro provided substantial research results from Israel, including peer-reviewed publications demonstrating efficacy of MSE in reducing maladaptive behaviors and fostering beneficial behaviors. Her facility is very large and operates with a high throughput. Current research includes use of MSE-like components to minimize stress and need for sedation during dental procedures, and this is also published. Other projects include using different lighting to reduce stress and use of hydro-therapy. She introduced important research principles like the cross-over study design and the use of quantitative measures (electrodermal activity, serum cortisol levels) to strengthen semi-quantitative measures (behavior checklists, video scoring, etc). Dr. Shapiro also related her experience advocating and working at a national level to gain acceptance of MSE officially in the Israeli government.
Monique Carlotti related her substantial experience in training over 3000 people in France since becoming a certified Snoezelen Trainer in 1992. She discussed the collaboration between approximately 15 institutions in France that all use Snoezelen, and meet monthly to discuss what works and what doesn't. She discussed the skills essential for every Snoezelen practitioner, those being 1) demand- be present for the person in the moment, let go of what is outside the MSE, 2) patience-give people time to respond to the Snoezelen room and become willing to explore and 3) trust- confidence in yourself, the team, the person we take care of and colleagues. She outlined the 3 step process of skills training provided to practitioners, which includes first, 3 7-hr days of training in concepts, sense experiments and practice sessions; second (after a 12 week period and after the practitioner has done about 10 sessions in the Snoezelen room), a 2 day training in which practitioners analyze their strengths and weaknesses in their practice, and are provided technical support; and third, long term management issues, providing support to the practitioners to help them continue the work. There are activities in which the practitioners work together to rebuild, help each other strengthen their commitment and skills, by talking
about cases, showing videos of sessions.
Dr. Marie Jose Cid and Montse Cervellera described the use of Snoezelen in Spain. Since first begun in 2001 Snoezelen programs have expanded about 400 spaces. Activities and actual practice varies by location, and many natural spaces are used, including beaches and other outdoor areas as well as more typical dedicated spaces. Contact with the environment around them is encouraged and promotes expression of feelings and preferences. A video was shown which highlighted various activities provided to several different individuals; activities were designed to achieve the 5 different "aims" or goals for Snoezelen participation: 1) emotional wellness, 2) communication, 3) relaxation, 4) cognitive development, 5) adapted behaviors and self-determination. The use of masks and costumes, fluorescent paints and paper, and creative uses of color were all highlighted in the video to demonstrate methods for conducting other types of therapies and educational activities within the Snoezelen space which are designed to improve cognitive abilities and communication skills in a relaxed and non-threatening way.
Dr. Jill Boldt Taylor gave a lecture in which she described the process of experiencing and recovering from a massive stroke, and further described in a very creative and entertaining way some issues related to brain development and function, and the processing of sensory information by the neurocircuitry in the brain. She related these concepts to the symposium topic of MSE. She discussed some aspects of brain development from birth through puberty and young adulthood, ending with her mantra "keep them alive til they're 25." she highlighted some differences in the right and left hemispheres, and emphasized that despite these differences, we have the ability to choose from moment to moment how we behave in the world. Dr. Taylor cited this capacity as the true ticket to personal freedom. She also provided a list of 10 very informative recommendations for recovery from a stroke which were based on her own experience and recovery process.