How-to-make-a-Sensory-Room-for-people-with-dementia

IntroductionThis guide offers advice on best practice regarding theengagement of residents living with dementia in dailyactivities that support their health and sense of wellbeing.Our aim is to equip carers, care workers and staff in carehomes with ideas and materials in order to provide multisensory spaces and stimulation appropriate for people livingwith dementia (in particular mid and late stages). We alsooffer guidance on the design of sensory spaces to meet thespecific needs and preferences of individuals, their familiesand care homes.You might find that not all of the suggestions will be suitablefor the person you care for, for your home or your particulargroup of residents. However, we hope that you can drawinspiration from How to make a Sensory Room for peoplewith dementia - Design Advice when creating your ownmulti sensory environment to suit both the needs of yourresidents and your daily work requirements.The guide has been developed on the basis of a researchstudy carried out in sixteen care homes in South Englandin 2013. The study looked into multi sensory facilities andenvironments currently offered by these care homes. Thisinvolved observation of sensory sessions and conversationswith staff including managers, activity coordinators and carestaff. Examples of good practice and useful suggestionswere recorded in order to compile this good practiceguide. Comments from many of the care homes are alsodocumented in the section on What care practitioners said.Practicalities & top tips refers to questions we werefrequently asked during the study. In addition, at the end ofthis guide you will find useful further reading including a listof key documents that helped to inform us prior to developingthis guide.4

People with dementiaand their needsThe term ‘dementia’ describes progressive disorders affectingthe brain such as Alzheimer’s disease, vascular dementia anddementia with Lewy bodies. These conditions present problemswith thinking, mood, behaviour, and the ability to take part ineveryday activity and leisure.If no suitable activities are provided and people living withdementia have nothing to do, they might become increasinglyisolated, frustrated, bored and unhappy. This is reflected inpeople walking around and searching, or becoming agitatedand emotional distressed. The absence of activities also affectstheir ability to maintain everyday skills such as self-care.Medication such as neuroleptics and other sedatives areoften used to control these problems. Although medicationachieves short-term results it frequently causes side effectssuch as drowsiness, which makes the problem worse asit reduces independence. Given these risks, good clinicalpractice should first exclude the possibility that these problemshave a physical cause (e.g. infection or pain) and engagein non-pharmacological approaches before consideringmedication. Stimulation and activity suitable and appropriatefor the individual will help keep the person active and included- which also helps both to maintain function and cognition,and to manage and moderate mood and behaviour. As withmedication, activities must be tailored to meet individual needs.However, choosing the most suitable type of activity for peoplein the mid to late stages of the disease is challenging. Giventhose people may not be able to participate in hobbies enjoyedin the past, it may be the sensory side of that activity thatneeds to be supported.For example, a woman who enjoyed baking may experiencepleasure being able to knead dough and/or to taste the finishedproduct, despite not being able to complete the activity asa whole. Identifying these parts is critical in constructing anactivity and an environment that is suitable and desirable forthe individual. This form of sensory activity may also provide alevel of stimulation, which increases awareness and attentiondue to the simplicity of the task. Matching the sensory demandof the activity with a well-designed environment will help theperson with dementia to take part.For residents with specific medical requirements a relevanthealth care professional needs to be consulted before followingthe advice in this guide.6

The benefits of a SensoryRoom in dementia careThe Sensory Room, also called Snoezelen or Multi SensoryEnvironment (MSE), is a space for enjoying a variety ofsensory experiences and where gentle stimulation of thesenses (sight, sound, touch, taste, smell and movement)can be provided in a controlled way. Stimulation canbe increased or decreased to match the interests andtherapeutic needs of the user. Such spaces, and how theyare equipped, offer a range of activities that can either besensory stimulating or calming in their effects.The concept originated in The Netherlands in the early1980s. Initially, the MSE was used for leisure activitiesinvolving adults with learning disabilities. Nowadays it isalso successfully applied in relation to other user groupsincluding people with cognitive and physical impairmentssuch as autism, acquired head injuries, stroke, and thosewith limitations of movement, vision and/or hearing. TheMSE offers the opportunity for an activity that is free fromcognitive demands in a space that can be used by careworkers as well as family members and informal carers.The conventional MSE, as provided by industry suppliers,contains a variety of equipment to stimulate the sensessuch as: bubble columns, solar projector casting themedimages, coloured optic fibres (for stimulating sight), CDplayer/sound system (sound), optic fibres to stroke andplait (touch), aroma distributor (smell), waterbeds andvibrating chairs (movement), equipment featuring switches(interaction).Figure 2 - 3: Examples of Multi SensoryEnvironments: the ‘White Room’ atWorcester Snoezelen, UK (top) and theSnoezelen room for people with severecognitive disabilities in De HartenbergCentre, Netherlands (below).9

Although little is actually known about how or why MSEs /Sensory Rooms work, research studies and anecdotal evidencehave shown that people with dementia find them enjoyable andrelaxing. After spending time in a Sensory Room, residents inthe later stages of dementia show positive changes in mood andbehaviour, and also an increase in attention to their surroundings.Staff feel that these improvements help with their relationship withthe residents and their daily work.Though it seems that these environments and activities havethe potential to improve a person's abilities and wellbeing, it hasalso been reported that Sensory Rooms do not always live up toexpectations and staff stop using them.The reason for this might be that often, when setting the spaceup, little thought is given to the design itself and how thisenvironment is going to be used. As a consequence, such spacesdo not always work for people with dementia and their careworkers because aesthetics and functionality of the spaces arenot satisfying and appropriate.The deficiencies of Sensory Rooms currently existing incare homes might be:The equipment and set up is not age appropriate: it lookstoo alien (rather like the interior of a “space ship” orlike a “light show”) in a home for older people making itdifficult for the residents to connect with.The imagery and items applied are too childlike andjuvenile in their aesthetic.The space is cluttered with distracting and unnecessaryaccessories or furniture visual focus therefore missing.Insufficient multi-sensory stimulation: not enough varietyof sensory experience is offered and there is often toomuch emphasis on visual stimulation with even the riskof visual over-stimulation.The success of these spaces is very much influenced by whatstaff think the room is for, how it is understood and consequentlyused by care workers - not just in times of a resident’s distressbut also as a means of positively enhancing peoples’ lives.Having a clear assessment procedure and guidelines on how touse the room will help staff and carers using it in an appropriatemanner. A number of assessment tools are available to dothis including the The Pool Activity Level (PAL) Instrument forOccupational Profiling (Pool, 2012) and the Sensory ProfilingTool (ROMPA).10

“The Sensory Room is useful because it enables carers to offeractivity and therapy: You can make somebody’s day for 15 min.”“The Sensory Room helps with the behaviour ofresidents and subsequently it becomes easier forstaff. Staff is giving some special time to residents,taking them to a special room away from the routine.”“It shouldn’t be just the activities team who is using it with the residents,some of the care assistants could very easily use the Sensory Room to goodeffect, especially when they are doing 1:1 work – and families and relatives.”“More natural things need to be included, such as a glowingartificial fire which will give the residents a more comfortablefeeling. You will get a reaction because that’s what they know.”“You shouldn’t have to come out for lunch. If people like it there they shouldn’t have tobreak for ordinary functions like lunch. But Sensory Rooms are never set up like that.”“You need to make the residents feel safeand comfortable so that they are able to calmdown and open up: it’s not mad stimulationyou need it’s calmness.”“I am struggling with raising the awareness amongst staff regarding what the purposeof a Sensory Room is. Very often I set it up very nicely and come in the next day andfind that awkward chairs have been put in and the room is used for storage. It is ok ifstaff takes breaks here but I don’t want to clear out empty cups etc.”“The Sensory Room was wrongly set up: it had a desk in it,was too small. It had a curtain that made it look like a doctor’soffice. Whoever set it up had no idea what they were doing.”“It needs to be a warm,soft and safe space.”12

How to make a Sensory Roomfor people living with dementia -Design AdviceMulti sensory stimulation should not be limited to a particularspace, it should be provided throughout the home in commonareas (including garden) and also residents’ bedrooms.First of all, the care home should look like a home and less likean institution. A stimulating but comfortable environment canbe created through a considered and appropriate use of colour,wall paper, attractive furniture, art work / images, appropriatedecoration, sensory corridors, and the introduction of naturethrough aquarium, pets, water features, plants and small trees.Figure 5 - 7: Example of a stimulating homeenvironment at Amy Woodgate House, a care homeowned and run by Royal Borough of Kingston uponThames. The interior design and environment wasdeveloped by project architect ECD Architectstogether with the care home manager, members ofcare home staff, and relatives of residents.For people with dementia a sensory stimulating environment mayfacilitate interaction between them and their carer enhancingcommunication on a verbal and non-verbal level. Increasingsensory awareness also supports information processing andraises awareness of the general environment. Sensory stimulatingsurroundings help working out where you are by the sensory cuesaround you, for example: ‘It is steamy, I can smell soap, I could bein a bathroom’ / ‘It is hot, I can smell onions, there are plates andcutlery – it must be lunchtime’).14

Figure 8: Bringing outside in through life sizephotographic wallpaper and garden furniture, inRoihuvuori Centre for the Elderly, Helsinki, Finland.15

Figure 9 - 10: Example of using colour and tactilematerial for furniture to make the shared living spacemore stimulating and interesting at Lady SarahCohen House, a nursing home in North London.16

However, the provision of a generally stimulating and comfortableenvironment does not necessarily eliminate the potential need fora specific multi sensory space - whether it is a semi-open areaor corner embedded in the general living environment or a multisensory room where it is possible to close the door for focusedactivities and sensory sessions.Where possible a multi sensory space should always be accessibleto residents at any time - whether it is a room (door should beopen or unlocked) or a sensory area. This ensures that residentscan use the space on their own whenever they want to, givingthem choice and control. It also makes for a more cost effectiveapproach which does not rely on staff having to take the residentsto the space.The room/area should be set up in such a way that it is safe for theresidents to access if unsupervised. Potentially harmful items orexpensive equipment should be stored/locked away or secured insuch a way that it cannot be dismantled or broken by the residents.Ideally the room/space should be located near the lounge wherecare workers can easily support the residents using the multisensory space.Exploring the environment will always come with an elementof risk. Each sensory experience should be assessed to alloweach individual to challenge and explore. This level of risk willbe different for each resident and it is the team’s responsibility toensure personal autonomy and dignity are maintained whilst highrisk exposure is reduced. Using guidelines such as those in thePAL with help reduce risk whilst maintaining an appropriate level ofengagement.When constructing a multi sensory space the following factorsshould be considered to make it successful and effective:Feeling comfortable and safeMeaningful and familiarMulti sensory experienceStimulation and relaxationControl and interactionAge appropriate and usableThe following sections give ideas and guidance how these featurescan be achieved through appropriate set-up, and selection ofappropriate items, equipment and technology.It also provides advice on colour and art work suitable for peoplewith dementia. At the end of the advice section an example canbe found how a dysfunctional Sensory Room can be transformed- with few interventions - into a multi purpose lounge whereresidents like to spend their time.17

Feeling comfortableand safeThe space you want to create should be an environmentwhere residents feel comfortable, safe and secure. It shouldbe an intimate, contained and quiet space with minimized orzero capacity for disturbance or distraction, neither visuallynor through loud noise or other people walking in and out.Providing a soft, warm and cosy atmosphere is vital.Using low-level sensory stimulation will activate theparasympathetic nervous system: inducing a state of calm.This will help the residents to relax and will reduce stressand anxiety, and subsequently enable them to better focuson activities offered.Textiles, fabrics andother soft materials:Soft blanketsTo be put on resident’s lap or wrapthemselves in.To provide soft touch to furniture which hasa non-textile surface.Soft cushions and soft toysFor residents to touch and cuddle.To make seating more comfortable.Plain textile curtainsTo cover ceiling and walls (from top to bottom)giving the space a softer and warmer feel and look,and softening sound and noise.To cover shelves/storage facilities for items andequipment not always in use (DVD/CD player,microwave, instruments, tactile objects).To divide a larger room and create a smaller spacefor more intimate or 1:1 sessions (partitions).Figure 11: Example for soft, tactile toy/muff: TwiddleMuff.18

Figure 12 - 15: Examples of the use of textilesand fabrics in Sensory Rooms designed by SariHedman in Kontula, Riistavouri and RoihuvuoriCentre for the Elderly, Helsinki, Finland(including figure on next page)19

Ensure fire safetyMake sure measures are taken to ensure fire safety in termsof keeping appropriate distance when using textiles andelectrical equipment and lights. Today most lighting technologyuses ‘cold’ LEDs which prevent the equipment from gettinghot. They are safe to use with fabrics. Equipment which needventilation such as projectors must not be covered / or givenenough space to avoid over-heating.20

Appropriate LightingFigure 16 - 19: Wall awash with colour: twoexamples of flood lighting (top and bottomleft); Example of wall washer light - neutralin look (top right); Example of a cloud ceilingwith sparkling LED (bottom right).Soft, indirect light for general lighting:No over-head lighting or at least this should be diffusedby using sails or translucent textiles covering ceiling.Wall mounted lights neutral in look e.g. wall washers.Colour washed walls and ceiling - immersing the spacein soft, coloured light that can be changed according touser’s preferences.Creating atmospheric, indirect lighting by usingsparkling net behind some fabric for the ceiling or a wall(see image)Dimmer switch:To facilitate soft and slow transition from light to darkerenvironment - to avoid the fear of darkness, start withthe main room lights on then slowly darken.To control and adjust the level/intensity of lightaccommodating individual preferences or activitiesoffered: balancing light and dark (if too dark it might bedisorientating and uncomfortable for the individual).21

DaylightNeeds to be softened and filtered through blindsor textiles.Make use of natural daylight if available instead ofartificial light only – important to achieve a balancebetween artificial and daylight if possible.Depending on the location of the room and window(e.g. facing South) blackout blinds might need tobe installed for controlling the level of day light –to be combined with translucent plain curtains orblinds to filter incoming light (see drawing).Blinds and curtains should properly cover thewindow to avoid uncontrolled and disturbing ‘lightspillage’ (as seen in image).Figure 20: Exampleof what should beavoided - using printedcurtains which allowlight to spill through.Figure 21: Illustration of theuse of blinds combined withtranslucent curtain allowing theoption to let filtered daylight in.22

Selective stimulating lights creatingvisual focus pointsColoured and slowly colour changing, free standing,hanging or wall mounted lights within easy view of theuser (e.g. fibre optic curtain, bubble wall, illuminatedballs or cubes, LED net or chain).Illuminated, colour changing, hand-held items/equipment(e.g. fibre optic strands, glowing balls or other shapes,fibre optic lamp).Projections (video projector, star projector)Figure 22 - 24 : Fibre optic lamp to be held by user (topleft); example of mounted bubble wall by TFH – quieterand safer alternative to free standing bubble tube, as it willnot fall over (below left); fibre optic strands (right).23

Figure 25 - 26: Shimmering fibre optic curtainscreate an interesting spatial feature (left: moveablecurtain at Worcester Snoezelen’s White Room) oreven semi enclosed space if applied with a curvedcomb (ROMPA) (right).Figure 27 - 28: Two views of colour changinglamp with matt translucent surface (left); glowingcube changing colour to be placed on floor (right).Figure 29: Glowing heart – example of an illuminated,programmable, tactile item to be held by user.24

AvoidVery dark spaces as residents might feardarkness or become confused if they cannotsee very well. The room should only be asdark as necessary for facilitating stimulationthrough selective lights.Glares and flickering lights.Lights and reflections moving around theroom on surfaces, walls and floor (e.g.reflection created by moving disco/glitterball) or irritating shadows as these can bemisinterpreted as insects or little animals.This may be confusing or frightening forpeople with dementia.Over stimulation through too many selectivestimulating items / lights: use only two at thesame time.Decorative lights. The space should be keptvisually neutral and calm to allow flexibilityin terms of colour and intensity of light. Suchdecorative lights may be useful in other partsof the home such as corridors or lounges butnot in the Sensory Room.Figure 30 - 31: Examples ofdecorative lights which should beavoided in the Sensory Room.25

Contact with natureBring the feeling of outdoors inside andinclude natural elements:Water featuresSuitable plants, e.g. edible ones such as herbs, or justdry twigsStones, shells, pine conesSalt lamp: salt rock of natural shape and texture,illuminated from insideMake use of access to garden if be possibleFigure 32 - 33: Plants and twigsto introduce nature into theSensory Room in RoihuvuoriCentre for the Elderly, Helsinki,Finland (far left and below)Figure 34: Example of a salt lampof natural shape and texture.26

Easy accessNo stark contrast between multi sensory room andrest of home:Create comfortable atmosphere and place familiaritems in the sensory room,Avoid the room looking like a cold ‘light show’ or‘space ship’ which might be confusing for olderpeople with dementia (see also advice under“meaningful and familiar”)Place some multi sensory equipment/items (e.g.bubble wall, tactile items) into general living areassuch as lounge or corridors.Sensory clues directing residents to the sensory space:Place more sensory art work particularly aroundthe area leading to the sensory room (see alsoadvice under “Art work”)Have music playing in the room to attract peopleto space.Gradual transition from light environment of thelounge or corridor:See advice under above section “Appropriate lighting”Visual contact with rest of homeAlthough there should be minimal distractions it is oftenhelpful to retain some visual contact with the rest of thehome so the individual does not feel isolated.Through an open door covered with a muslin curtain,chain curtain or optic fibre curtain which is noninterfering.Figure 35: Fibre optic curtainat the entrance to the SensoryRoom at Kontula Centre forthe Elderly, Helsinki, Finland27

Over-stimulationProvide a visually calm space with a visual focus:De-clutter the space, remove unnecessary decoration,Store away all items and equipment not used for thesession which could be visually disturbing (see section“Practicalities/storage” in this guide)Limit visually stimulating equipment:‘Less is more’ - provide visual focus by using only afew stimulating items at the same time,People who are sensitive to stimulation may find itoverwhelming if too much equipment is on at thesame time.Eliminate disturbing noise:Use quiet equipment: lighting equipment or projectorscan sometimes be very noisy (sometimes to the extentthat the music or sounds played cannot be heard)because of the need of powerful ventilators – technologyemploying ‘cold’ LEDs is quieter as they do not need asmuch ventilation.Figure 36: Example of a visuallyover-stimulating room.To help maintain focus on anactivity the space should not befilled or cluttered with too manysensory items and /or other objectsthat are likely to over-stimulateand distract attention. People withdementia find it difficult to filterrelevant stimulation when there iscompeting stimuli.28

Comfortable furnitureSoft, tactile surfaces/material:Soft fabric - impervious to fluids - for upholstery (availablee.g. from Panaz upholsteries or Pineapple furniture).Blankets or sheep skin to cover sofas and armchairs ifmade of vinyl.Comfortable and relaxing positions:Offer foot rests (e.g. stools) so feet and legs can becomfortably placed in higher position.Opportunities for lying down (e.g. couch, floor matt).Rocking chairs - the linear movement of rocking backand forth reduces arousal and helps the person to relax.Serving snacks and drinksTo enhance the sense of comfort and ‘break the ice’; toprepare users to relax or engage (see also informationincluded in section on “Multi sensory experience” )Pleasant climateComfortable room temperature:A fan might be necessary, particularly in Summer, asequipment and people’s bodies generate heat.Good air quality and sufficient oxygen level:Regular airing of the room: open window or apply airconditioning unit.29

Meaningful and familiarApart from stimulating the senses your Sensory Room / multisensory space should be equipped and designed in sucha way that it can provide familiar, personal and appropriateexperiences that are relevant to the resident’s life and stage ofdementia. Everyday objects, e.g. set of keys or a little bell, and/or tailor-made objects, e.g. textile books or sensory cushions,can trigger off memories or start a conversation.The design should create opportunities for exploring andengaging in appropriate activity giving the person a sense ofpurpose. Making the room feel familiar will help with transitioninto the room and residents will be more motivated to go into thespace and join in the sensory activities.Appropriate use of technology:Technology needs to be multi-sensory and age appropriate.This includes the way the equipment is presented to aperson with dementia.The equipment should be accessible, appropriate andoffer a range of possibilities for engagement. A balanceis needed between hi-tech and low-tech equipment – thechoice between high-tech and low-tech may be more aboutaccessibility and preference.Consider what are individual likes and dislikes as a degreeof personalisation helps to meet each individual person’sneeds (“bespoke high-tech”). Low-tech options may helpwith orientation; for example, familiar items that also have astrong sensory component. High-tech options may help withpeople with more severe dementia, as the stimulus is moreintense and easier to detect.There should always be a mix of natural things and technology.Modern technical sensory equipment can be made moreaccessible, less technical and easier to connect with whencombined with something natural and familiar, e.g. combiningmodern lights with textiles such as sheer fabrics or nature suchas dry twigs.30

Figure 37: Sheer textiles covering LED lights adding atactile feel as well as diffusing and softening the light.Figure 38: Twigs next to a bubble tube makes the equipmentappear more natural and accessible – as seen RiistavouriCentre for the Elderly at Helsinki, Finland.31

A mix of the new and the familiarEveryday and/or old items and familiar imageryProjecting familiar imagery of a glowing fire, nature,landscape, children or old photographs with streetscenes, using DVD player and data projector.Everyday objects and tools (e.g. from the kitchenfor women or from the workshop for men), oldclothes (e.g. an old wedding dress, hats) withfamiliar and interesting tactile features.Objects from nature e.g. shells, conquers, fur, fruitsand vegetables.Playing old songs and musicAttracting residents to the room – music can thenchange slowly into more modern calming music andsound-scapes once session has started (if necessary).Figure 39 - 40: Hats and bags are rich in tactile and visualqualities. Such items can be placed throughout the homein the general living areas - in easy reach for residents andalso in a familiar place such as wardrobe or coat hooks.32

Offering appropriate tactile stimulationTactile objects which have a relevance to the individualencourage touch and other forms of engagement;whereas, items presented in an abstract manner -without context - tend to be less effective.Figure 42: In these examples tactilestimulation is offered in a way thatmakes it more difficult for the individualto understand and connect with. Alsothere is too much going on around thetactile pieces making orientation andfocus very difficult.Figure 41: The German Shepard fake fur – padded, framedand placed in the corridor – has been extremely successfulwith residents in Highbury New Park care home in NorthLondon. The item was bought at the local market.Preparing the room for individualsensory sessionHaving a few familiar, maybe personal items on display- this will help the individual to settle and relax beforeengaging in activities.Setting up the room in advance according to personalpreferences or the residents’ level of dementia.Cultural relevanceCultural and ethnic background of the individualneeds to be considered - this will help the personsettle and provide a reference point for reminiscence,habits and routines.33

Multi sensory experienceAll the senses need to be addressed! This includes sight,touch, sound, smell, taste and movement. Our study hasshown that the visual sense is often overvalued, in somecases even over-stimulated. In contrast, the provision oftactile stimuli is limited as there is not enough variety ofmaterial and objects to touch and explore. Similarly thereis often not enough stimulation of hearing, smell and taste.Stimulating the vestibular (moving in space, orientation andbalance) and kinaesthetic sense (position and movement ofarms and legs) is mostly neglected.A good solution here is to use equipment, items and materialthat are multi sensory in design. For example, musicinstruments or scented cushions made from various materialsprovide a wider opportunity to explore visual, tactile, audioand olfactory (smell) stimulation and encourage movement.Many kinds of food are also multi sensory such as fruits,colourful cake or sorbet providing not just taste but alsotexture and colour.Meaningful multi sensory and reminiscent experiences canbe created by combining various stimuli addressing differentsenses under a particular theme. For example a walk on thecoast: the sound of waves and seagulls, a breeze, a videoshowing the sea and the beach, sand and some shells totouch. This can create a virtual environment bringing theexperience of the seaside indoors.SightLight and colourA selection of 1-3 gently animated lights provided byequipment such as bubble walls, programmable lights,fibre optics, LED nets, star/cosmos laser projectors, handheld illuminated objects (more information and imagesunder “Comfort and feeling safe” and “Meaningfuland familiar”)Kaleidoscope, crystal ball, crystals – such objects canalso be used in day light.Bright objects and stained glass that can be placed inthe window reflecting the rays of the sun (can be usedthroughout the home)AvoidOverly bright lights andlights that move or flashquickly.Such lights can causeconfusion and overstimulation.Too many differentstimulating lights at thesame time - a visualfocus needs to beprovided.34

Films and VideosA data/home cinema projector connected to a DVDplayer could be used rather then one of the traditionalSensory Room projectors with rotating image wheels asit offers more flexibility in terms of what can be shown(a range of different images and videos). Personalvideo recordings could also be shown to facilitatereminiscence. The projector can be permanentlyinstalled on the ceiling and should feature low noise andlow heat.Old films and feature movies with simpler plots couldbe used to help prompt memories. Other sensorycomponents could be used in conjunction with the movieto help enrich the sensory experience e.g. provision ofstuffed toys such as a cat when the film features a cat,actual dancing when the actors are dancing, snacksreplicating foods being shown on the film.Films showing natural themes and simple life scenessuch as playing children accompanied with familiarmusic or music written specifically for the movie– contain no or minimal narration, do not requireundivided attention.Scenes from nature can include: landscapes, waterand sea, forests, flowers, fish swimming underwater,animals, and glowing fire.Films featuring abstract, calming, non-memoryprovoking images (e.g. slowly animated shapes andcolours - no negative memories or thoughts can betriggered) and music promoting relaxation.Figure 43: Examples of films with natural themes – stills from“Meadow” (left) and “Rhossili”, two 60 min films by CalmFilms(calmfilms.com).35

Projections on fabricProjections - in particular more abstract imagery - canbecome more interesting and stimulating if projectedonto textiles, either a single curtain or layers oftransparent fabric such a muslin, adding a tactile andspatial element to the projected image.The image is duplicated when projected onto severallayers as it is caught on each layer separately.Figure 44: Projection onto fabric transforms theimage into a more spatial and tactile experience.36

Material of different optical qualities catching the lightin different waysShiny textiles, e.g. satin, velvet, and other glossysurfaces, e.g. foils.Transparent and sheer textiles, lace – creatinginteresting effects and colour mix when layered.Wooden items with carved/3D texture,latticework, meshes.Figure 45: Cushions with covers madefrom visually interesting textiles such asvelvet and satin with simple prints.Figure 46 - 47: Fans from fragrant sandalwoodwith laser cut decoration that reminds of laceor latticework – playing with these fans isstimulating vision, touch, smell, hearing andmovement. These fans can be easily purchasedvia the internet at low cost.37

Food and natural things found outdoorsColourful fruits and vegetables, cakes.Flowers, colourful fishes.Shells, pine cone, etc (more below under “Touch”)MotionBlowing bubblesObjects that move in the wind, e.g. wind chimes, ribbonsor curtains from light weight and sheer fabric.Films with slow moving animated shapes and colours.TouchActive tactile stimulation: objects, items and equipmentoffering a variety of tactile experiences such as:Different material/texture and surface quality: textured/smooth, soft/hard, etcDifferent shapesEveryday familiar thingsMoving objectsTemperature: warm or coldClimate: breezeWet, dry, stickyPassive tactile stimulation: providing massage (hand, feet,neck, head) and foot bath in combination with scent, e.g.massage oils such lavender and melissa.Natural objects and everyday things with interestingreminiscent surface qualitiesShells, conkers, feathers, leaves, stones, dried plants,woodSand, seeds or dried beans to run fingers throughPolished woodThings made of leather like leather ballsThings from the kitchen or workshop safe to useSet of keys, little bellsCeramic and stone tilesSand paperVariety of textile pieces and fabrics samples, e.g. satin,silk, corduroy, fleece, denimCrocheted blankets, soft cushions, soft toysSheep skin and fur38

Most of these objects feature multi sensory qualities (tactile,smell, visual, sound) and, if safe to use and not too fragile,can be placed in rummaging boxes or baskets throughout thehome.Figure 48 - 49: Shells, stones, bark and driedplants providing not only tactile but also visual andreminiscent stimulation.Keep smaller, ‘bite-sized’objects out of reach assome people in laterstages of dementia mightput things in their mouth.39

Sensory cushions and blankets, sensory books – made fromvarious textile material, with zips, ribbons, buttons, pocketsCan be purchased or self-made – although they are like toysthey should be age-appropriate in their aesthetic in terms ofcolours, material and images applied, NOT patronising or childlike – see examples below.Tailored to the individual’s preferences making the experienceof a multi-sensory session more personal and familiar.Sensory blankets with pockets: some people just like to holdthe corner and some people like to put their hands in thepockets, hide things inside them.Tailored to gender of advantage: for women more floral motifsand brighter colours, for men toned down, darker colours.Figure 50: Examples of sensorycushion especially designed forpeople with dementia stimulatingvision, touch, hearing andmovement - distributed by PSS, acharity that provides care, healthand community services in UK.Figure 51: Sensory cushionsat Lady Sarah Cohen Housenursing home in North London:the colouring is harmonious andsophisticated yet interestingand stimulating – verysuccessful and age-appropriate.40

Sensory armchair covers and pocketsComfortable and calming to allow residents to self-soothewithout drawing attention to themselves.Provides instant sensory and reminiscent stimulation.Can be self-made - similar to sensory cushions.Deep pockets with plenty of space to hide objects,images, etc.Figure 52: Similarly to sensory cushions, sensory armchair covers canhave buttons and ribbons attached, or feature a patchwork of varioustextile materials and techniques such as crochet and knitting.Tactile activitiesPlaying with different media: sand, water, jelly, flour,fragrant play dough.Making art work: the process of making is multi sensoryand can involve finger-painting, tearing and crunchingpaper, sticking, sprinkling, mixing etc.Figure 53: Example of art workwhere the process of making isa multi sensory experience: oil,beads, sequins and buttons aremixed on foil and then sealed(seen at Worcester Snoezelen)41

Small vibrating items: cushions or tubesStimulate interaction and learning.Can provide fun experience and social interaction when usedin group or 1:1 session.Should be switchable to give the user control when to startand end vibration.Figure 54: Vibrating tubeand cushion, supplied bye.g. ROMPA.AvoidVibrating furniture, as it is lesssuitable for people with dementia asthey have difficulties understandingwhat is happening and couldbecome distressed.Figure 55: Wheat cushionsagain can be stimulating on amulti sensory level providing theexperience of warmth, stimulatingfeel, visual and tactile stimuli ifdecorated with interesting prints orembroidery, and smell if scented.Experiencing different temperatures: warm and coldApplying wheat cushion or cherry stone pillows which can beeither heated in a microwave or chilled in the freezer.Providing hot water bottles wrapped in soft and tactile cover.FootbathServing cold or hot drinks, ice cream or warm snacks.42

ClimateThis can be considered as part of thermoregulation as well asorientation, in essence another sense. It helps us to orientate toour environment and can stimulate reminiscence which can leadto increased wellbeing and increased awareness. For example,a warm room with sounds of the seashore might suggest beingon holiday.SoundAuditory stimulation is very effective for mood enhancement,relaxation, and cognition. It includes a wide range of sounds,ranging from natural sound (e.g. birdsong, waterfall, urbanenvironment) to generated sound such as music. Both can beenjoyed life or played back through a sound system.A multi sensory space should provide both, a good soundsystem with CD player as well as items that produce life soundssuch as musical instruments or water features.RelaxationNatural sounds (e.g. wind chimes) and recordings of ambientsound-scape such as rain fall, wind blowing through trees, oceanwaves, or calm ‘new age’ music are helpful for relaxation.StimulationClassic music, music from a specific era or a resident’s personalchoice to stimulate cognition and reminiscence.Played in the background while other activities are going oncan improve mood, and even memory, and helps the resident toengage.Musical InstrumentsAuditory stimulation does not have to be passive only. Musicalinstruments, particularly percussion instruments, are very effectivein encouraging active participation, social interaction and evenphysical activity and movement.They also can provide stimulation on a multi sensory andreminiscent level if beautifully embellished (e.g. rain sticks) or ofinteresting shape, texture and material (e.g. bells, violin).Sing-along and rhythm sessionsPercussion instruments can also be found or easily made fromthings around the house (water bottle filled with dry rice, boxescan be drums etc) and be used for stimulating sing-along andrhythm sessions.43

Figure 56 - 58: Examples of rainsticks - hollow tubespartially filled with small pebbles or beans that havesmall pins or thorns arranged on the inside. When thestick is upended, the pebbles fall to the other end of thetube, making a sound reminiscent of rain falling. If madeof transparent material one can see the movementsof the beads. Rainsticks can easily be self-made anddetailed instructions can be found on the internet.Figure 59: When running the stick fromthe frog’s mouth over the knuckles at hisback a sound similar to a croaking frog iscreated stimulating hearing and memory.Figure 60: The music box stimulateshearing, touch, vision and movement.Make sure the look and decoration of thebox is age-appropriate and not too juvenile.44

Figure 61: An Ocean Drumencourages hand and armmovement. Beads insideroll over the bottom likewater rolling over the shore.Different speeds producedifferent sounds. Stoppingand starting suddenly createscrashing wave sounds.Figure 62- 63: Beautifully decoratedmusical instruments stimulatingcognition and active participation.45

SmellOlfactory stimulation can be facilitated through a wide range ofactions and activities. Smell can be actively stimulated througha bespoke smelling session or aromatherapy session, or just bein the background providing a pleasant and fresh atmospherewhen entering the sensory space.Bespoke smelling sessionsPreparing smell pots: small box with lid and some cottonwool, filled with spices such as cloves or cinnamon,herbs such as mint leaves, lemon juice or zest, etc.Important: knowing about individual preferences ofresidents and past experiences to tailor smelling sessiontowards it.Scented room/spaceAroma diffusers and blends of essential oils (aromatherapy)are an effective way of creating a general ‘background’smell in preparation for a sensory session or to differentiatethe area or room from the rest of the home.Lavender for calming and relaxationLemon and mint for refreshing, uplifting and stimulationBergamot for balancing and calmingHand massageUsing scented massage oils, such as lavender.Care does need to be taken when applying oils andlotions to the skin. Check for any adverse reactionsbefore proceedingScented bagsSmall fragrant bags attached to blankets or cushions oreven placed in small ‘handbags’ or pockets attachedto armchairs.Figure 64: Smallscented bags withcolourful bobblesplaced inside anotherbag to be explored.46

The smell of everyday thingsWood, sandalwood, silk, sheep skinFresh herbsFruits – in particular citrus fruits when peeled and cutChocolate, coffeePeppermint teaSpicesAnimalsContinued throughout the home and the dayStimulating smell should not be limited to the sensory area/space but should be applied throughout the home and thewhole day.Using scented soaps and lotions for personal care.At meal times odour of fresh bread or cookies fillingthe house.Fragrant items placed in the lounge (e.g. fragrantflowers if possible)TasteThe sense of taste is often under-used as a sensory componentof a multi sensory experience, however, it is a powerful way ofunderstanding what is happening around us. Taste can provokememories as well as emotions. Taste is also highly personal so itneeds to be ensured that staff have a clear understanding of likesand dislikes of the individual.Texture is also an element that provokes response. For example,soft creamy textures can be soothing (sucking chocolate).Residents may also have strong responses to certain textures so,again, care needs to be taken. Examples of different tastes andtextures are given below.Figure 65: Examples of treats that can be served in theSensory Room for gustatory stimulation.47

TasteDrinks with unusual flavours, e.g. elderflower cordialTreats: chocolate, sherbet, ice-creamPeppermintMarmiteEnsure you have a range of salt, sweet, sour, bitter andumami/savoury.TextureCrisps and raw vegetablesYoghurt, jellyPrawn crackers, pop cornEnsure you have a range of different textures such ascrunchy, soft, melting.Stimulating the sense of taste is not about eating and feeding.The goal is to provide stimulation: small tasters and snacksfor comfort and enjoyment to encourage residents to respondand reminisce. Offer something that people would see as aluxury or a treat, not the everyday taste. A sensory session canalso be used to encourage residents to have more fluids withinthis time.Care needs to be taken with participants who have specificdietary needs or swallowing difficulties. A health careprofessional might need to be consulted for further advice.Movement (vestibular andkinaesthetic sense)The vestibular sense is the sense that provides us withinformation about our movement in space. It is responsiblefor spatial orientation and balance - for creating an awarenessof the location of our heads and bodies in relation to the ground.The kinaesthetic sense (also called ‘proprioception’) is thesense of the position and movement of our arms and legs inrelation to one another. It tells us where our body parts arelocated at that moment, and how much strength we need toexert when completing various task.Both senses are addressed by movement and different bodypositions. Moving our bodies can either stimulate or relax.Spinning or random movements tend to be stimulating whereaslinear movements are relaxing, for example, we rock a babyto help it sleep but dancing energetically is stimulating.48

In a Sensory Room or multi sensory space stimulation of bothsenses can be facilitated through:Different seating positions and something to lie down onReclining chairs, bean bags, sofas, foot restsMatt on the floor, sofa bed, chaise longueBe aware that most residents don’t like the water bedas due to the constant movement, this can make themfeel unsteady.Opportunities of movementLinear movement for calming: rocking chair -rocking back and forth reduces arousal and helps theperson to relax.Circular movement for stimulating: head movementand reaching out beyond sitting position.In respect to circular movement, moving the head, arms or legscan be encouraged through the positioning of equipment anditems so that residents have to reach out to access or operateequipment and items, as well as through activities offered.Interactive equipment can play an significant role in stimulatingarm movement.Stimulating and encouraging movement is particularlyimportant for residents in wheelchairs as they may not normallyexperience much movement.Figure 66: Rocking chair at KontulaCentre for the Elderly, Helsinki,Finland: elongated base preventsthe chair from tumbling over.Ensure health + safetyRocking chairs need to be fitted witha locking mechanism to facilitatebetter moving in and out of chair.49

Stimulation and RelaxationA Sensory Room should be seen as a sensory toolbox with anumber of different items to stimulate the senses at differentlevels of intensity. For example, bright lights to stimulate and softlow level lighting to relax. The person setting up the room alsoneeds to remember that what relaxes one person may stimulateanother. A person who is sensitive to stimulation is likely torespond quicker. By completing an in depth personal life storystaff will be aware of what things stimulate or relax each resident.The selection of each piece of sensory equipment or item shouldthen be based on that person’s interests and needs. Outcomesfrom each sensory session need to be recorded alongside whathas been stimulating or relaxing so that other staff will knowwhich pieces of equipment or item and/or which sensory activitywork best at either stimulating or relaxing.By having a Sensory Room/Space it is possible to createeither a relaxing or a stimulating environment. Below are somesuggestions of relaxing and stimulating pieces of equipment.What is stimulating?Sight: lights of high intensity, colour red, reminiscent imagesand objectsSound: loud music, tempo that is heart beat rate or faster,sing-along tunes, abstract soundsTouch: textured objects, spiky balls, random contactTaste: citrus fruits, peppermint, sour sweets, sherbetSmell: citrus smells, peppermintMovement: random movements, spinningWhat is relaxing?Sight: low level, slow changing lighting, fairy lights,Christmas tree lightsSound: quite music, tempo that is heart beat rate or less,continuous background music, natural sounds (seashore,bird song)Touch: deep pressure such as hand massage, stroking, softfabrics such as fur, velvet, silk or fleeceTaste: milky foods such as chocolate, milk pudding or yoghurtSmell: lavender, smell of baking cakes or breadMovement: linear rocking such as a rocking chair, gentlerocking in time to music50

Control and InteractionInteraction and engagement at the right level for the individualis important as it promotes brain activity and helps the personmaintain interaction skills such as learning and communication.Doing things for yourself also increases confidence and feelingsof self worth. Hence residents using the Sensory Space/Roomshould be allowed and encouraged to choose sound / music,colour and intensity of light, imagery etc. themselves. It is aboutgiving somebody the opportunity and empowerment to choosewhat to explore and at somebody’s own pace.Being able to control the stimulation give a sense of mastery overthe environment. This facilitates the user to modify the amountand type of stimulation they receive and help prevent thembecoming over-stimulated.Low techControl and interaction can be provided and encouraged onvarious levels, for example on a low tech level by offering the userto play with simple musical percussion instruments, music boxesor interactive tactile cushions.High tech: integrated switchesOn a more high-tech level (for example interactive lights)control and interaction can be achieved by using an appropriateswitching system and/or fitting age appropriate switches to theequipment which can easily handled by this user group.Here it is important that the user is made aware of the opportunityto select and choose and how to use the switch as it might not beas obvious as with low-tech items. Choice can also be introducedas the activity progresses.Figure 66 - 69: Examples of switches to control sensory equipment 1) Grasp switch: can be held in the palm ofthe hand and activated by squeezing the rubber hand grip, supplied by SpaceKraft. 2) Wireless switch: User canfocus on task not the leads on the table. Turn-taking and sharing is as easy as passing this brightly colouredswitch around. 3) Shape switch: slim-line red square to be pressed. 4) Soft koosh switch: simple yet wonderfullytactile. 2 – 4 supplied by ROMPA.51

Switches can also encourage social interaction and sharing. Inparticular, smaller vibration pieces such as vibrating cushionsor tubes are useful as they are easily controllable for the userand can be shared.Controls can be adjusted to adapt the complexity of the activityfrom simple to difficult. This could be simply changing thecolour of the bubble wall or tube or a more complex activitysuch using an iPad control to change the colour and theme ofthe whole room.Switches can be of various material and making to suit theneeds of the person, such as tactile encouraging touch, tosqueeze, tiny touch sensitive, movement sensitive for nontactileperson who might not want to press a switch.52

Age appropriateand usableChoosing sensory equipment can be challenging as many ofthe items that are of the right sensory level are often aimed atchildren. It is important to select equipment and items that givethe right level of stimulation but are not perceived as juvenileor childish, in particular in respect to the aesthetics. Also, herethe feelings and views of family and relatives of the residentsneed to be considered if space and equipment appear not ageappropriate. However, images should not be as complex thatthe person with dementia cannot understand them (see alsosection “Art work”).Figure 70 - 71: Successful examples of ageappropriate toys for adults: the movement of theglitter or the iridescent coloured ribbons suspended inclear liquid creates an enchanting display of light andcolours which can be fascinating for people of all ages.DignityThe way care workers interact and communicate with the personwith dementia is critical in maintaining dignity: if the interactionis appropriate and the piece of equipment is targeted at the rightlevel of ability then dignity is maintained. Focus on what kind ofstimulation it provids and reflect on how it might make you feel.A validation approach can also be used when presenting itemsor equipment by talking about what that type of stimulation mightremind you of. For example, the optic fibre spray is twinkling: itreminds me of Christmas lights, how did you spend Christmaswith your family?53

Staff need to be clear about what is to be achieved by the pieceof equipment: for example is a nursing chair appropriate forolder people? This type of chair providing a linear rocking action(suitable for relaxation) might be considered for the SensoryRoom as its design reduces the chance of the individual fallingout. However, if it is referred to as the nursing chair this could beperceived as inappropriate.Figure 72: This is sold as ‘Constructionbox for people with dementia’ – targetingmen in particular. However, due to itsbright colours and simplified details itlooks too much a toy for a young childrather then an older adult and shouldrather not be offered to maintain dignity.Figure 73: A more appropriate and dignified example of an itemwhich can keep men with dementia occupied and stimulated. Theaesthetic, the material and colouring of this lock box reminds moreof real things the individual might have experienced in his life.Figure 74: Example of a nursing chair asit can be currently purchased on the highstreet. It gives the advantage of safety,in particular when getting in and out, butmight be perceived as inappropriate ifreferred to as ‘nursing chair’ in a homefor older people with dementia.54

UsabilityApart from the issue surrounding aesthetics and connotation,the usability of sensory equipment and items is of highimportance too.A multi sensory space needs to be set up and designed in sucha way that sensory equipment and items to be explored arein easy reach or/and sight for the residents. As many of theresidents might be bound to a wheelchair ‘eye level’ for them islower then for a person walking or standing. For similar reasonsa person might not be able to bend down. So items placed onthe floor would be out of reach for them.Also, equipment should be ergonomically designed to suit theabilities of older people with physical limitations and not ableto grab and hold things easily anymore. This is particularlyimportant if integrated switches are employed for user control.55

ColourKeep room neutral and lightOff-white or beige for walls, ceiling and furnitureThis provides flexibility as you can vary the mood andtone of the room or parts of the room through colouredlight which can be programmed to change or chosenmanually by the resident or the person accompanyinghim/her.Use brighter colours for accentuating and drawingattentionColoured items, cushions or blankets stimulatingengagement and helping with identifying seating furniture.Colouring certain parts of the room (e.g. through colouredlight) to draw attention to this area.Stimulating and calming coloursRed is physiologically stimulating and increasesbrain activity – however, red can sometimes also beassociated with fire by people with dementia of whichone needs to be aware of.Calming colours: green and blue.Warm and cool coloursCool colours: blue and violet – make a smaller roomappear slightly larger.Warm colours: red and orange – make a room appearwarmer and slightly smaller than it actually is.Dark/light contrast for better visibility and clarityContrasting floor against furniture and walls to helpbetter visibility and visual discrimination56

The ‘Ageing Eye’As we age a yellowing and thickening of the lens in the eyeoccurs. As a consequence colours are perceived differently.Violet is perceived as grey.Vivid colours appear less saturated.Reduced ability to see colour contrast.Reduced ability to discriminate blue colours asthey appear more like green.Avoid patterns or visual barriersSudden visual changes of the flooring can be perceivedas barrier catching the attention of the person withdementia who has then to make a decision to cross. Thiscan be challenging.Similarly, patterns might be seen as obstacles or mightbe confusing as they might be perceived as differentheights (e.g. stripes and chequered patterns may beperceived as steps or holes).57

Art work / sensory artArt work in the Sensory Room?Art work should not necessarily be placed within the multisensory space to avoid unnecessary distractionand cluttering.Having sensory art work outside of the multi sensoryspace/area though can facilitate a better transition fromlow key stimulation to more intense everyday stimulation,and draw people’s attention to the room encouragingthem to enter, complementing the Sensory Room.Less complex yet stimulatingMore appropriate as it is less challenging.Certain level of abstraction, simple sceneries,yet recognisable.Multi sensory drivenMore stimulation through tactile features (even if it isnot to be touched) and various optical qualities such asshiny and glimmering.Sensory art can be made by residents: The actualmaking of it can be a multi sensory experience.Providing focus pointsPlaced in corridors and living areas helps people toorientate and navigate within the home.Can be used to give the area or room a ‘name’, e.g.“room with the beautiful picture” which helps to createa destination.Figure 75 - 76: Examples of appropriate art work: The texture in the flowers and background add a tactilefeeling to the image making it more interesting and interesting (left); The boldness and vivid colours of theflowers as well as the spatial effect in the photograph create an stimulating and captivating effect (right).58

Figure 77: Art work by Martin Jones (Artinsite), one of the paintingsproduced for the Marjory Warren dementia ward at King’s CollegeHospital London. Showing a certain level of abstraction yet beingrecognisable as London landscape, Jones’ works are liked by thepatients, staff and visitors alike.Figure 78 - 80: Examples ofsensory art where residentscontributed to the making.59

Example of a transformedSensory Room:before and afterBEFORE (October 2013):The room is cluttered with furniture and various items, someof them broken or dysfunctional. Also it seems that the room isfrequently used as a space to temporary store/put excess furniture.The whole appearance is uninviting and extremely distracting andconfusing as no visual focus is provided. The room is locked andonly used with the activity coordinator.However the room has good potential as it is very spacious andlight, and has direct access to the garden. Also, there is a adjacentstore room which could be used to store additional items andequipment for multi sensory stimulation not always needed.Figure 81 - 83: The Sensory Room beforethe transformation.60

AFTER (June 2014):The room has been transformed into a pleasant multi functionallounge which is of reminiscent character on one side (left image)and features sensory equipment on the other. Liked for itsstimulating, yet calm and soft atmosphere a destination has beencreated regularly frequented by the residents. The door to theroom is kept open inviting the residents to stay and from here tostroll into the garden. The store room is in use to store away extraitems and furniture if not needed.The wallpaper image adds a homely feel to the space on the leftwhere activities with the residents such as cake decorating takeplace. The new furniture and curtains have an elegant appearanceand the colouring of the furnishing has been matched with thecolours of the image. Both gives the room a modern yet ageappropriate feel.Figure 84 - 85: The room after the changes.A new sound system has been added (not seen in photos)replacing the low quality transportable CD player. Having musicof good sound quality yet moderate volume playing is anotherattraction for the residents to spend time in the room.The reduced arrangement of the space on the right attempts tocreate a visual focus with the bubble column which is a positivemove considering the cluttered room from before. Yet, the spaceis lacking warmth, comfortable, soft feel and stimulation on amulti sensory level. With some additional interventions this spacecan be improved and transformed into a successful sensoryexperience (see “Our Advice” below).61

Our AdviceIn order to improve the room further we advise the following:Change the head lights (currently the same as in the corridor:bright yellowish lights, no dimming):Install wall washers and head lights which produce a diffusedand soft light.Install dimmer for adjusting brightness according to activitytaking place.‘Hide’ the sound system (currently placed on a desk next to thedoor):Store in lockable cabinet which should visually blend in withsurrounding walls making it ‘invisible’ to further de-clutter thespace and to make the room safer for residents.Spread out the loud speakers in different corners of the roomfixed up on the wall: improving the sound quality and audibilitywithout having to increase the volume.In respect to creating a moresuccessful multi sensory space:Remove any unnecessary items left over from previousinstallations (such as the box on the wall next to bubblecolumn and cables hanging down)Fill up the water of bubble column and check out if the light isworking correctly (it should reach to the top of the column)Change the furnitureReplace current chairs with more comfortable armchairs and/orsofa or even rocking chair facing towards bubble column.Remove small table if it is not absolutely necessary as itbecomes just another obstacle for residents.Add more tactile itemsPlace soft cushions, blankets, sheep skin, tactile armrest coverson furniture and even floor.Cover walls that surround the bubble tube with textile curtainsfrom top to bottom - to give this area a softer and more naturalfeel (as suggested in image below).62

Install curtain to partition the space to create a more intimatesensory corner with blocked off light from window, other part ofthe room can still have day light and access to gardenCurtain can be double layered (mixing opaque fabric blockingout lights with see-through textiles) to make it more interestingon a visual and tactile level (see image below)Add another stimulating light, as for exampleFibre optic lamp (which can be stored away if too much)LED net behind sheer textilesColour washing wall lightsInstall projector (on the ceiling) and DVD player – providesmore flexibility regarding visual stimulation as a range of imagerycan be shown, including sequences of old films, scenes fromnature, landscape, children playing, and slowly moving abstractshapes and colours.Figure 86: Example with colour washedwall (blue) on the right hand side.63

Figure 87: Example with LED net behinda sheer fabric.64

Practicalities / top tips“Instead of saying that we cannot haveit. It is about how we can alter theenvironment to compensate for.“How do I get started?Start by assessing your resident with for example the PALoccupational profiling tool and download the guidance forrunning a sensory session. Build up your sensory toolbox usingideas from the advice section. Make sure you have somethingto stimulate sight, sound, touch, taste, smell and movement.Find a quiet space and start with one or two pieces of equipmentfollowing the PAL guidelines.What size should the room be?Your sensory space should be big enough for 4 - 6 people, nottoo small to avoid claustrophobia and the feeling of being lockedin. Curtains can be used to divide the room and to create a moreintimate spaces within a larger room for 1:1 sessions. A biggerspace will always give you more options and flexibility then asmaller space. It can be helpful, for maximum use of space, tohave a multi-purpose/mixed use space.Where should my sensory space be located?It should be in easy reach for the residents as well as staff, ifpossible next to living areas or other places where staff caneasily observe the residents without having to go with them.This allows individuals to access a quiet space on their ownwhen the main living area is too noisy. Direct access to a gardenis of great advantage as it can be included in sensory sessionsencouraging residents to go outside.If I don’t have a spare room, what can I do?Find a quiet corner where you can set up a multi sensory area,or create a sensory trolley you can take to a resident’s room. A‘sensory trolley’ can contain a range of sensory items that canbe used and set up in a resident’s room such as a fibre opticlamp, soft toys, textiles, tactile cushions, music instruments,projector, things to smell or taste.65

How do I store my sensory equipment?Even if you have a dedicated sensory space it is a goodidea to keep your sensory items and smaller, more fragileequipment stored away, for example in a locked cabinet oron shelves behind curtains. A lockable space also allowssafe unsupervised access to the Sensory Room.Keeping excess sensory equipment as well as the soundsystem or microwave out of sight is safer, but also, moreimportantly, prevents the person becoming over-stimulatedby too many distractions and cluttering. People withdementia find it difficult to filter relevant stimulation whenthere is competing stimuli.It may help to make the storage space, either a curtain or acupboard, ‘invisible’, e.g. cupboard doors or curtain samecolour as walls. They should be as neutral and plain aspossible in look blending in with the rest of the room to notattract unnecessary attention, to prevent distraction and tohelp maintain the focus on the sensory equipment.What if I only have a small budget?You don’t have to have lots of expensive equipment. Ifyou are planning to purchase some equipment from thesuppliers, buy one or two pieces from MSE suppliers andsupplement your sensory kit with either products fromdomestic suppliers, cheaper local purchases, or makesensory items yourself (see “Design Advice”). There shouldbe a balance between high tech (possibly costly) and everydayand familiar items.The choice of technical equipment should be based onfollowing points: it must be flexible and serve a range ofdifferent purposes (e.g. projector with DVD player); andmust be sufficiently robust to survive the handling by peoplewith dementia (long lasting quality equipment).Figure 88 - 89: Examples ofstorage space for sound system,microwave, and sensory itemshidden behind a curtain.DIY / hand made objects create a sense of ownershipamongst staff but may carry an inherent risk if handledwithout supervision. The risk for the individual should beassessed rather than a blanket ban being put in place.66

How do I maintain and clean sensory equipmentand furniture?Equipment purchased by the suppliers and retails should comewith details of how to maintain and clean it which should alwaysbe followed. A check of equipment should be made on a monthlybasis (more frequently if used daily) to check for damage, anyreplacement batteries or bulbs needed and any missing items.Bulbs and batteries can be purchased from local hardwarestores.Tactile textile items frequently used such as cushions, blankets,soft toys etc need to be washable or easy to replace. It is a goodidea to purchase multiple items of the same kind if they areinexpensive and very popular.Fitting furniture with fabric material rather than vinyl or plasticis always better as the latter can be uncomfortable to sit onproviding an unpleasant tactile experience. Choose coveringtextiles impervious to fluids.Where can I get equipment and material?Suppliers of products for people with dementia:Best of Alzheimer’s Products - http://store.best-alzheimersproducts.comActivity Products for Dementia - http://www.active-minds.co.uk/Activities to Share - http://www.activitiestoshare.co.uk/AlzProducts - http://www.alzproducts.co.uk/Ode: authentic food fragrances - http://www.myode.org/calmfilms - http://calmfilms.com/listSuppliers of textiles impervious to fluids:Panaz upholsteries - http://www.panaz.com/healthcare/Pineapple furniture - http://www.pineapplecontracts.com/fabrics/waterproof-fabrics/4Suppliers of sensory equipment:ROMPA - http://www.rompa.comSensory plus - http://www.sensoryplus.co.ukSpace Kraft - http://www.spacekraft.co.ukSensory Technology - http://www.senteqdirect.co.uk/Experia - http://www.experia-innovations.co.uk/Sensory Toy Warehouse - http://www.sensorytoywarehouse.comTFH - http://www.multisensoryenvironments.com; http://www.specialneedstoys.com/uk/67

Further useful informationAlzheimer’s Societyhttp://alzheimers.org.ukAlzheimer’s Society fact sheetshttp://www.alzheimers.org.uk/factsheetsAlzheimer’s Society guide to the dementia care environment. J. Poolhttp://shop.alzheimers.org.uk/product/guide-to-the-dementia-careenvironment/BrainHub – A HealthHub Portalhttp://www.brainhub.tv/dementia/homeCollege of Occupational Therapy tool kit: Living well in care homeshttp://www.cot.co.uk/living-well-care-homesDSDC Dementia Services Development Centre,University of Stirlinghttp://dementia.stir.ac.uk/designThe King’s Fund: Environments of care for people with dementia;Enhancing the Healing Environmenthttp://www.kingsfund.org.uk/projects/enhancing-healing-environment/ehe-in-dementia-carehttp://www.kingsfund.org.uk/projects/enhancing-healing-environmentLiving sensationally – understanding your senses.Winnie Dunnhttp://www.jkp.com/catalogue/book/9781843108719NICE guidelines – Dementia: Supporting people with dementia andtheir carers in health and social care(particular reference to 1.7)http://www.nice.org.uk/guidance/CG42/chapter/IntroductionPerson centred approach to riskhttp://www.helensandersonassociates.co.uk/blogs/livingambitions/2011/9/7/a-person-centred-approach-to-risk.aspxPool Activity Level (PAL) - Instrument for Occupational Profilinghttp://www.jackiepoolassociates.org/pal/68

References, picture creditsand acknowledgmentsReferencesMargaret Calkins, How colour throws light on design in dementia care,Journal of Dementia care, Vol: 10, Issue: 4, pp 20-23 (2002)Winnie Dunn, Living Sensationally: Understanding your senses, JessicaKingsley Publishers, London (2008)Jackie Pool, The Pool Activity Level (PAL) Instrument for OccupationalProfiling (4th Ed), Jessica Kingsley Publishers, London (2012)Jackie Pool, The Alzheimer’s Society guide to the dementia careenvironment, Alzheimer’s Society, London (2007)Picture creditsCover image; Fig 1; 4-17; 20; 23-25; 27-33;35; 37-42; 44-51; 53-55; 60-64; 66; 75-77;80-85; 88-89 © Anke JakobFig 2Fig 3Fig 18Fig 19Fig 22Fig 26Fig 34Fig 43© Worcester Snoezelen© Ad Verheul, De Hartenberg Centre, Netherlands7140 Pella 325 Plaster Wall Washer;source: thelightingsuperstore.co.ukCloud Ceiling Material by TFH;source: specialneedstoys.comMultisensory ‘snoezelen’ room for dementia patients, Simeon Brody, 05/02/2010, Leeds Partnership NHS FoundationTrust, Mount Centre; source: communitycare.co.ukCurved fibre optic comb; source: rompa.comWhite salt lamp; source: alohabay.comVideo stills; source: calmfilms.comFig 56-58,65 images sourced from internetFig 59, 70Fig 66Fig 67-68Fig 71Fig 72Fig 73Fig 74Fig 78-79© Ezzidin AlwanSwitches; source: spacekraft.co.ukSwitches; source: rompa.comClear light up iridescent ribbon ball;source: sensorytoywarehouse.comConstruction box for people with dementia;source: activitiestoshare.co.ukLock box; source: store.best-alzheimers-products.comHaywood glider nursing chair and footstool;source: johnlewis.com© Lesley Collier69

The authors wish to thank:Members of the project’s Advisory Group, for sharing theirknowledge and expertise, including Prof. Paul Chamberlain(Sheffield Hallam University), Prof. Mary Chambers (KingstonUniversity & St George’s University of London), Alessio Corso(Senior Lecturer, London South Bank University), Prof. HilaryDalke (Kingston University), Fiona Fowler (Dementia WorksLtd), Maizie Mears-Owen (Care UK), and Jane Roberts(Worcester Snoezelen); all staff of the care homes thatparticipated in the research study conducted between July andOctober 2013; all participants of the focus group workshop inFebruary 2014 including activity coordinators from four Londoncare homes, and Denis Forte and Matt Brown (both KingstonUniversity); Prof. Jane Harris and Jane Gibb (both KingstonUniversity) for their support and input throughout the project;Sari Hedman for the introduction to three care homes in Helsinkifeaturing multi Sensory Rooms designed by her; Rose Elliotfrom project partner Care UK; Bethany Trueman from WorcesterSnoezelen; Esther Shelley, Kate Strudwick and KarolinaCialkaite (all Kingston University) for the graphic design of thisguide book.70