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Education and Training in Developmental Disabilities, 2008, 43(3), 334–341
© <strong>Division</strong> on Developmental Disabilities
Therapeutic Interventions in <strong>the</strong> Ne<strong>the</strong>rlands and Belgium in
Support of People with Profound Intellectual and
Multiple Disabilities
Carla Vlaskamp and Han Nakken
University of Groningen
Abstract: For several reasons, people with profound and multiple disabilities may be offered a variety of
<strong>the</strong>rapeutic interventions. Thus far, researchers have shown a limited interest in providing an empirical base
for <strong>the</strong>se interventions. Research is needed on <strong>the</strong> <strong>the</strong>oretical rationale (if any), <strong>the</strong> supposed ‘modus operandi’
and <strong>the</strong> claimed benefits of <strong>the</strong>rapeutic interventions. As a first step, this paper offers an overview of <strong>the</strong> use of
<strong>the</strong>se interventions. A total of 48 settings in <strong>the</strong> Ne<strong>the</strong>rlands and Belgium were included in this study. Results
show that some interventions are very frequently used, with Snoezelen, Sensory Integrative Therapy, Equine
Therapy, Basic Stimulation and Aroma<strong>the</strong>rapy being <strong>the</strong> most common. Only one of <strong>the</strong>se five has been subjected
to a number of carefully designed studies. Nearly a third of all <strong>the</strong>rapeutic interventions currently in use are not
clinically evaluated. Of those that are evaluated, more than half are only evaluated monthly or even less
frequently. The article ends with a call for an effective research strategy to separate interventions that are
beneficial to people with PIMD from those that are unsubstantiated.
In <strong>the</strong> support of people with profound intellectual
and multiple disabilities (PIMD), practitioners
in centers for special education, day
services centers and residential facilities use a
series of <strong>the</strong>rapeutic interventions that aim to
achieve a broad spectrum of claimed effects,
ranging from ‘feeling good’ and ‘restoring a
natural balance’ to developmental effects and
regaining functions. These interventions or
procedures are generally not carried out by
medical staff but by direct support staff members
or <strong>the</strong>rapists (such as physio<strong>the</strong>rapists or
speech <strong>the</strong>rapists). In practice-oriented journals,
popular magazines and on television and
<strong>the</strong> internet, a large range of <strong>the</strong>se interventions
or <strong>the</strong>rapies are documented. They may
claim ‘to cure’, such as Gentle Teaching, for
example, which promises to cure self-injurious
behavior by using unconditional acceptance
and a gentle touch. They may promise impor-
The authors would like to thank prof. dr J.H.
Hogg for his comments on a previous version of <strong>the</strong>
manuscript. Correspondence concerning this article
should be addressed to Carla Vlaskamp, Department
of Health Care Psychology, University of Groningen,
Grote Rozenstraat 38, 9712 TJ Groningen,
The NETHERLANDS. Email: c.vlaskamp@rug.nl
334 / Education and Training in Developmental Disabilities-September 2008
tant sounding but vague benefits, such as
Therapeutic Touch, which states that <strong>the</strong>re is
‘a natural human potential which can be actualized
through <strong>the</strong> intent to help or enhance
<strong>the</strong> recipients’ own ability to support
<strong>the</strong>mselves towards wholeness,’ or ‘Dolphin
<strong>the</strong>rapy’ which states that ‘swimming with dolphins
makes children with special needs learn
up to four times faster and more intensively.’
These kinds of interventions are used
throughout <strong>the</strong> human services area, and
while no area or enterprise has been immune
to <strong>the</strong> phenomenon of unsubstantiated <strong>the</strong>rapeutic
interventions, <strong>the</strong> field of profound
and multiple disabilities appears to be particularly
vulnerable. This may be due to several
reasons. Firstly, <strong>the</strong>re is <strong>the</strong> size and complexity
of <strong>the</strong> disabilities of those with PIMD. In
addition to <strong>the</strong>ir profound intellectual and
severe or profound motor disabilities, individuals
with PIMD also have a high prevalence of
sensory disability (Nakken & Vlaskamp, 2006;
Schrojenstein, Lantman-de Valk et al., 1997;
Van Splunder, Stilma, Bernsen, Arentz, &
Evenhuis, 2003). Fur<strong>the</strong>rmore, as well as <strong>the</strong>se
impairments, people with PIMD have an overall
risk of developing medical complications
and almost all require regularly administered