Sniff research in Autism

An older article from 2015 on scent and sniffing pleasant and unpleasant odors, noted that Autistics sniffed at pleasant and unpleasant odors with the same intensity whereas neurotypicals sniffed more intensely with pleasant odors and less intensely with unpleasant odors.

We wonder if the more intense sniff is increasing the intensity of the scent and thus contributing to increased sensory overwhelm to scent?

We would love to see some research into whether this could be developed into an easy intervention. We searched articles this week and could not find interventions but please let us know if there are some.

We would propose an intervention where Autistic children could learn to visually identify potentially unpleasant scents (this would need to be individually tailored)  and also learn to control the intensity of their sniff to decrease the overwhelm. This could focus on scents that are more commonplace in everyday environments (schools, shops) and where the scent is impacting on occupations.

It has been difficult to research the olfactory (scent) sense in Autism, partly due to the difficulties with accuracy of measurement. A new precise and easy to use system has been developed – the odor pulse ejection system. It is described in this article:

This system was designed to more accurately measure olfactory processing including odor detection, identification and evaluation. Findings of the study using the odor pulse ejection system suggest differences in aspects of olfactory processing for autistics, including olfactory working memory and/or attention.

References

Article: a mechanistic link between Olfaction and Autism

Xu, M., Minagawa, Y., Kumazaki, H., Okada, K., & Naoi, N. (2020). Prefrontal Responses to Odors in Individuals With Autism Spectrum Disorders: Functional NIRS Measurement Combined With a Fragrance Pulse Ejection System. Frontiers in Human Neuroscience, 14. https://doi.org/10.3389/fnhum.2020.523456

Designing a mental health unit with sensory zones

The NSW Government is investing $20 million to help hospital managers improve the therapeutic environment inside acute mental health units – isn’t that great news!

Julie and I have had a lot of conversations over the years about designing our ideal mental health inpatient unit and in this blog we discuss some of the main points.

Our ideal mental health unit would be able to cater for the people in the unit on many levels. It would be able to cater for mental health needs and some areas would be calming, whilst other areas would be suitable for socialising, creativity or exercise. It would be able to cater for the different sensory needs and some areas would be really quiet and low scent, while other areas would support loud music and strong sensations. People would be able to freely move to the areas that they needed in order to change how they felt through using their senses. This could include to a reading nook or a soothing garden, or a zone with sensory modulation equipment. The design would use trauma informed principles so it would have a homely feel and there wouldn’t be disinfectant smells and fluorescent lights and same curtains everywhere. It would have interesting, helpful and creative activities on the units……. We had so many ideas that we decided to write chapters in our book* on it!

The book has a section on designing or renovating sensational spaces in hospitals, mental health units and aged care facilities. This includes the concept of sensory zones so that people are able to move to the zone that meets their sensory need at the time. In the book there are 19 zones with equipment suggestions and design needs for each of them. 5 of the 19 zones are listed below:

Exercise zone or gym

• non slip mats on the floor with vinyl rectangular cushions sectioning off the area so it is not walked over

• ideally near a wall. On the wall could be posters with exercises that could assist with anger (e.g. wall pushups, simple yoga and stretches)

• equipment including weights, basketball hoops and an exercise ball to sit on or bounce     

Low stimulation zone

• eye masks

• ear plugs, noise-cancelling headphones, music and earphones

• wrap or blanket

• comfortable, rocking or swinging chair

• lower light, light with dimmer switch, low lamp

• white noise or soundproofing of zone

• nil odour (takes away the scent)

• no talking in zone.

Sensory modulation item zone

Sensory modulation items set up for individuals to access

• weighted cushions, wraps

• blankets, shawls

• textured cushions

• cardboard boxes to personalise a distress tolerance kit

• scented items

• icy spray

• fidget items

• books for sudoku or crosswords

• warheads, sour lollies, mints

• dencorub, eucalyptus rub.

 *Items are assessed and selected with the intention of clients using them independently, without needing a staff member to access or unlock them.

Calm garden zone

• garden with variety of plants including variety of leaf shapes and textures

• scent to be carefully considered. Would not recommend strong scents in garden zone. Could have a separate zone with scented plants (scent exploration zone)

• good to have soothing quality to plants and zone

• water feature e.g. pond or waterfall or water sculpture

• no hidden or dark zones to assist with soothing (so can let go of hypervigilance).

• area for ball games.

 Family interaction zone

• indoor or (ideally) outdoor area for parents and children

• swings or playground equipment that promotes interaction, connection and co-regulation

• sandpit or water play

• games table

References:

*“Sensory Modulation Resource Manual (2018)” , J O’ Sullivan and C Fitzgibbon.

https://www.barnesandnoble.com/w/sensory-modulation-carolyn-fitzgibbon/1128221915

https://www.pinterest.com.au/SensoryMod/mental-health-unit-design/

https://www.health.nsw.gov.au/patients/mentalhealth/Factsheets/built-therapeutic-environment.pdf

A Sensory Explanation and Solution to Emotional Eating

Emotional eating (also known as stress or comfort eating) is when food is used as a coping mechanism to manage emotions, rather than to satisfy hunger. People at one time or another will use food as a reward or to self sooth during times of stress, but problems arise when this becomes an entrenched pattern, an automatic reaction in response to feelings of anxiety, upset, loneliness, anger, fatigue or boredom.

While emotional eating does have a short term pay off, it rarely helps in the long term. It does not address underlying issues, often leads to intense feelings of frustration, guilt and feeling out of control, and can also contribute to additional health problems.  

There are a range of unhealthy behaviours that people use to cope with emotions, including smoking cigarettes, drinking alcohol, taking prescribed or illicit drugs, and comfort eating.  Reliance on any of these can reduce our ability and confidence to cope and lead to problems with addiction. It is interesting to note that many specialists in the field are calling for the term addiction to be replaced with “ritualised compulsive comfort-seeking” as they feel it better describes the behaviour and because it so often results from the experience of childhood adversity.

A sensory explanation to emotional eating

Research shows that sensory input can be a powerful mechanism to help a person positively change how they feel. Eating and drinking is an activity that incorporates a variety of sensory input including taste and smell, touch (from the food and drink being held in the mouth, temperature, and the mechanics of licking, sucking and sipping) and proprioception (bodily awareness gained through mouth movements such as chewing and swallowing). This input is registered by the brain and facilitates increased feelings of calm, grounding, focus and attention.

The sensory aspects of eating and drinking (the smell of hot chips, the taste of chocolate milk, the chewing and swallowing of biscuits) may provide people with the neurological input needed to help shift how they feel. While the goal of changing negative feelings is a good one, some strategies used to achieve this (such as over-eating) may result in negative outcomes. Different sensory strategies could therefore be adopted to provide the desired sensory input, without the negative effects of emotional eating on health and well-being.

A sensory solution to emotional eating

When adopting a sensory approach to emotional eating, consider the following:

1.      Do you recognise certain triggers to your emotional eating? Are there particular emotions, situations, times of the day or pressures that make you more vulnerable to reaching for food to cope? For example, between meetings at work, when you feel alone, or at night when feeling tired. These are the times where conscious application of replacement sensory strategies will be very important.

2.      Are there particular foods you tend to reach for? For example, do you crave specific tastes like sweet (chocolate, cake or ice-cream) or salty foods (chips, spring rolls, pizza). Do you prefer certain textures (crunchy, chewy, or velvety smooth?). Being aware of preferred sensory input can assist with finding different effective options.

3.      Identify alternative strategies to use instead of the usual food choices that provide oral sensory input you may be seeking, without the calories. For example:

·         sugar free chewing gum or sugar free lollies instead of mint chocolate biscuits

·         home popped corn instead of crisps

·         flavoured teas (mint, chai, lemon) instead of iced coffee or milk shakes

·         Mineral water with cut up fruit instead of soft drinks or jelly lollies

·         crunching vegetable sticks or ice cubes

·         sucking ice cold water through a straw or sports bottle

·         Cleaning teeth with peppermint toothpaste

4.      Try using replacement sensory input that does not involve food/ eating:

·         Body movement (jump up & down on the spot, go for a walk, stretch your muscles, dance to music, swim, lift weights, skipping rope)

·         Fidget with something (stress ball, rubix cube, theraputty, a bag of marbles, rub hand cream into your hands, art or drawing/doodling)

·         Strong &/or preferred aromas (coffee, perfume, citrus, lavender)

·         Touch input (cold washer over eyes, deep heat or eucalyptus rub, warm shower or bath, put something heavy in your lap)

5.      Identify key trigger times/scenarios when you are more vulnerable to emotionally eat, and actively replace that behaviour with a new one involving a sensory activity. For example:

·         In-between work meetings, take 2 minutes to go to the bathroom and clean your teeth, make a fruit tea, go for a walk around the office and chat to a colleague, do some stretching exercises.

·         Rather than sit down with food to watch TV at night, start reading a book chapter each night, or do something arty/crafty.

·         Have healthy alternative snacks on hand to reduce risk of buying/eating unhealthy options.

·         Go for a walk when alone in the house, rather than eat. See if there are any walking groups, family or friends that might be interested to join you.

It is important to practice alternative sensory strategies regularly, as this will help your brain form new healthier habits to replace the old ones. With repetition and persistence, new neural pathways will increase in strength and the brain’s ability to access them becomes faster and more efficient. This process directly counters the old neural pathways, thus reducing the power of the older, unwanted habits.

References

Ellen, J (2017). Addiction doc says: It’s not the drugs. It’s the ACEs…adverse childhood experiences. Found in https://acestoohigh.com/2017/05/02/addiction-doc-says-stop-chasing-the-drug-focus-on-aces-people-can-recover/

O’Sullivan, J & Fitzgibbon, C (2018) Sensory Modulation Resource Manual: Changing how you feel through using your senses. Lightening Source, Melbourne.

Smith, M; Segal, J & Segal, R (2018). Emotional Eating -How to Recognize and Stop Emotional and Stress Eating. Found in https://www.helpguide.org/articles/diets/emotional-eating.htm

 

Feedback on the Sensory Modulation Resource Manual from different professional groups

The Sensory Modulation Resource Manual was published earlier in 2018 as an ebook and paperback. We have been getting some feedback from different people and professional groups about what they find useful about the book. We have had feedback from Nurses, Teachers, Occupational Therapists, Parents, Architects, Dentists, Non-Government workers and many others.

Nurses:

Clinical Nurses in Mental Health are finding that the book provides useful resources for using sensory modulation to reduce seclusion and restraint in the inpatient unit. This includes information on designing different spaces or zones within the inpatient unit for different sensory input (sensory spaces), suggestions for equipment for the sensory spaces and a guide to getting starting in using sensory modulation with a client. In June 2018, the NSW government allocated $20 million to improve therapeutic environments within mental health units. The Sensory Modulation Resource Manual is a useful resource for this project. 

Teachers:

Teachers are reporting that the Sensory Modulation Resource Manual is useful in understanding the individual sensory preferences of the children in the classrooms and tailoring strategies to the individuals. The section on calming strategies has been popular, in particular using the playground for calming. High school teachers and Guidance Officers have liked the lists of strategies to improve focus, and decrease anxiety.

Occupational Therapists:

Mental Health OTs are benefitting from the resource section of the book eg handouts on sensory modulation,  sensory kits, self soothing and strategies for anger and agitation. New graduate and student OTs are reporting that the section on getting started with using Sensory Modulation as an intervention is very useful. Student OTs are the ones who are purchasing the ebook in the greatest numbers (this is the cheapest option) however other OTs are preferring the paperback version.

There are increasing numbers of OTs in the physical and paediatric areas who are finding Sensory Modulation is able to be applied to their area of practice.

Parents:

Parents of adolescents have been interested in the section on alternatives to self harm, developing sensory kits, substance use and understanding sensory seeking in adolescents. A number of parents are finding that their children are using weighted items and cold water to calm down.

Architects

Architects have been positive about the information on understanding sensory processing and the chapter on Sensational Spaces, and the impact that the environment has on changing how people are feeling.

Allied Health/Health Practitioners/Support Workers

The Sensory Modulation Resource Manual has been of interest to a wide range of people who work in the health field. This has included chiropractors, ophthalmologists, dieticians and dentists. Interest areas have included the information on the senses and sensory preferences, and strategies to assist the particular individuals that they are working with.

Sensory Modulation Resource Manual

E-book: available on Amazon

Paperback: available at bookstores including Barnes and Noble, Avid Reader, Book Depository, Amazon.

Reviews on Amazon:

"A fantastic resource and contribution to the field of sensory modulation and occupational therapy in mental health."

"Excellent practical book which brings together the neuroscience and strategies that work in practice!!"

 "This is an excellent resource for all teachers, counsellors and those in school leadership. It will open our eyes to adapting our enviornments to suit the diverse needs of learners."

Having a heavy dog sit on your lap can be calming!

Water can cool down a temper in the playground

Designing a sensory space - lots of ideas in the book

Using Nature 'To Change How We Feel Through Using Our Senses'.

The health benefits of nature have been acknowledged in records dating back to ancient civilisations such as Egypt and China. There are numerous theories postulated to explain this connection, including the role of nature in human evolution as well as the relationship between nature and stress reduction, self-regulation and restoration.

Studies conducted over the last two decades continue to demonstrate the strong connection between nature and well-being, for example:

·         Contact with ‘blue space’ (living near the ocean) is associated with reduced levels of psychological distress (Nutsford et al, 2016).

·         Views of nature (ie - mountains, oceans, waterfalls, star filled skies) create feelings of wonderment and awe, altering our experience of time and increasing feelings of unity, connection, patience, and a desire to help others (Rudd, Aaker & Vohs, 2012).

Viewing or engaging in nature can be considered a sensory activity as it uses multiple sensory systems, including sight, sound, smell, touch and movement. Intentional contact with nature to change how we feel (for example, sitting under a tree in the park to help feel more at ease or digging in your garden to relax) are examples of sensory modulation at work.

While active participation and engagement in nature (ie- visits to gardens, nature trail walks, going to the beach) is the ideal way to foster this wellbeing, it is not always possible for all people at all times. However, contact with aspects or representations of nature still promote positive changes in wellbeing and functioning. For example, studies have shown that even sensory components (ie- views, sounds, smells) of nature can improve recovery from surgery, reduce pain levels and increase work performance (Frumkin, 2001).

Some suggestions to incorporate aspects of nature in our day to day lives:

1.      Have a nature zone or space at homes by creating a garden or with pot plants or indoor plants.

2.      Indoor plants in offices and on desks or window sills.

3.      Pictures or coffee table books of awe-inspiring views of nature

4.      Nature screensaver on computer or tablet, or photos on a smart phone

5.      Listening to sounds of nature (birds, ocean waves, rainforest)

6.      Smells of nature (lavender, herbs, eucalyptus leaves)

7.      Aquarium with fish in the waiting room of a clinic or office

For more information on sensory modulation, sensory environments and sensory spaces, see ‘The Sensory Modulation Resource Manual’ via amazon.com or bookstores.

 References

Frumkin, M (2001). Beyond Toxicity: Human health and the natural environment. American Journal of Preventative Medicine, 20(3): 234-240.

Nutsford, D; Pearson, A; Kingham, S & Reitma, F (2016). Residential exposure to visible blue space (but not green space) associated with lower psychological distress in a capital city. Health and Place, 39(5): 70-78.

Rudd, M; Vohs, K & Aaker, J (2012). Awe Expands People’s Perception of Time, Alters Decision Making, and Enhances Well-Being.  Psychological Science, 23(10), 1130-1136.

O’Sullivan, J; Fitzgibbon, C;(2018) Sensory Modulation Resource Manual.

Using Balance, Movement and Proprioceptive Input to Reduce Anxiety

There is growing evidence that balance, movement and proprioception (the sense or awareness of our body in space) can play an important role with managing anxiety.

Maintaining balance requires input from a number of systems, including proprioceptive and vestibular (movement) sensory systems. These sensory systems have direct pathways to the parts of the brain that modulate the autonomic nervous system, which controls the stress response. Research has shown that increasing balance, movement and proprioceptive input actually reduces sympathetic nervous system activation, effectively turning down the stress response and reducing anxiety.

It makes sense when you think about it. If we feel less balanced and more unsure/unsteady on our feet, or if we are not registering sufficient information from our muscles and joints about where our body is in the environment, this can heighten feelings of stress, anxiety, and feelings of being more unsafe/unstable as we are moving through the world.

Actively increasing balance, movement and proprioceptive input will help a person feel more connected to their body. This increases a sense of grounding, stability, safety and calm, which can reduce or even alleviate feelings of anxiety. This input can be increased by engaging in activities that require balance, movement, sustained muscle contractions or deep pressure input.

Examples of increasing balance, movement and proprioception input to reduce anxiety:

·         For children who are feeling anxious or nervous in the morning before school, play a game of ‘balancing on one foot’. To make it more fun, balance while waving arms, touching nose, wriggling raised leg or even use a balance board (now available in stores like Kmart). These activities are also useful during school, after breaks or between lessons.

·         Participating in movement and muscle resistance exercises at the beginning or end of the day, to increase feelings of calm and grounding, for example yoga or pilates poses, using repetitions with hand weights, skipping with a rope, or stretching exercises using therabands (now available in stores like Kmart).

·         Incorporating resistance and deep pressure input into your daily activities and routines, for example watering the garden with buckets of water, reading a book with a weighted cushion, weighted toy or pet in your lap, or going for a swim, a walk or a bike ride.

References

Medical News Today (2009). Link Between Anxiety and Balance Problems in Children Suggested By New Research From TAU https://www.medicalnewstoday.com/releases/136495.php

Science Daily (2009). Mind Out Of Balance, Body Out Of Balance. Tel Aviv University. http://www.sciencedaily.com/releases/2009/01/090122141226.htm

Cool strategies to self regulate on a Mental Health Inpatient Unit

Mental Health inpatient units are increasingly using Sensory Modulation strategies to provide options for people to self soothe and self regulate. One strategy that many people find useful is the use of cold temperature items. This can include using ice sprays, disposable ice packs, zip lock bags with cold water, cold slushies, cold water in sinks, cold stress balls, and chill towels.

Cold temperature can be useful for several reasons:

·         It can cool the body when it is hot eg when anger flushes the face and hands.

·         Cool water used in conjunction with breath holding can invoke the mammalian dive reflex and reduce the heart rate. (this makes it unsuitable for people with heart conditions or anorexia nervosa without prior medical clearance).

·         as an intense sensation, it can be an alternative to self harm

·         the sensory input can feel grounding and reduce dissociation.

·         Some people who experience night sweats find that sleeping with a chill towel is very cooling and relaxing.

On an inpatient mental health unit, it can be useful to have a small fridge with cold items in it that can be used by people to self regulate. Another option is to have a sink that can be filled with icy cold water and used by distressed, angry or agitated clients to calm through placing the head in the cold water and breath holding. This technique is used within Dialectical Behaviour Therapy as a distress tolerance skill (TIP skill).

The cold water could be plumbed so that it does not overfill. A non-slip mat could be placed next to the sink to reduce the risk of falls. The sink would be useful in an area that is available to people when they need to use it.

Further suggestions on Sensory Modulation items for mental health inpatient units are in the Sensory Modulation Resource Manual.

References:

Sensory Modulation Resource Manual paperback: https://www.barnesandnoble.com/w/sensory-modulation-carolyn-fitzgibbon/1128221915

Sensory Modulation Resource Manual ebook: https://www.amazon.com.au/Sensory-Modulation-Carolyn-Fitzgibbon-Sullivan-ebook/dp/B0791WJZ5N

https://dailydbt.wordpress.com/2011/02/17/tip-skills/

DBT skills training handouts and worksheets (2014), Linehan

Research Ideas

Dear Students and researchers.

At Sensory Modulation Brisbane, we have clinicians who often identify topics for research, but who are unable to research them due to time or logistical restraints. We are very aware of the need for further research on Sensory Modulation, so we are going to list ideas through blogs when we have them.

We request that you acknowledge Sensory Modulation Brisbane (Carolyn Fitzgibbon and Julie O’ Sullivan) as inspiration. Also ,we request that you identify Sensory Modulation as an intervention being championed by Occupational Therapists. We would be very interested in hearing if you do proceed with any of our research ideas. Here are our first ideas:

Use of scent of a familiar person/place to decrease anxiety or panic .

Parents of babies and also people with puppies, use the scent of the person to provide calming. In older children and adults, scent could also be utilised with those who do not feel safe.

OT researchers could use this process:

1.     Identify a scent that reminds the person of a safe person, place or memory.

2.     Identify a way to incorporate this scent into daily occupations.

3.     Assess if anxiety is decreased.

Clinical applications include:

•  Mum sleeps with a hanky and then child with anxiety takes this to school to assist with separation anxiety

• Young man has a sprig of rosemary in his backpack as it reminds him of his Grand Dad’s garden.

• Young woman smells the deodorant that her Mum uses when she is anxious. (I had one client who ceased having panic attacks when she tried this)

• Person feels safe at the beach, so brings a little jar of sand home, and smells this when feeling anxious.

Soothing and Grounding Sensory Modulation Strategies for clients with Severe Anorexia Nervosa

Clients with severe anorexia nervosa are often asked by treating teams to not exercise due to the energy and calories that this takes. However ceasing exercise often takes away a strategy that has been being used to calm and ground. Other strategies for providing vestibular and proprioceptive input could be explored with this clinical population.

Researchers could use this process:

1.     Interview a person with Anorexia Nervosa to explore the type of exercise that they enjoyed.

In collaboration with the individual, explore options for sensory modulation that could be meeting a similar sensory need. This may include:

• grounding sensations – squeezing a hand grip or theraputty.

• soothing  – explore other vestibular options eg hammock , chair swing.

• feeling in control – tight clothes such as thermals, T-Jackets.

Or sensory modulation could be used to explore soothing options for clients with anorexia nervosa.

Using warmth with clients with Severe Anorexia Nervosa.

Clients with Anorexia Nervosa on inpatient units are often finding it difficult to maintain their core body temperature.

Sensory Modulation strategies could be increased with these clients including using electric blankets, electric hot water bottles, hand warmers, pyjamas heated in dryers etc.

Clients could be interviewed before and after using a heated item, to explore whether this improved their emotional state.

Reference:

"Sensory Modulation Resource Manual" (2018), J O' Sullivan and C Fitzgibbon

Ideas 2: 

The above blog generated some interest so we have added some more_

Do medical procedures increase oral hypersensitivity in children?

Some children develop oral hypersensitivity and some then have difficulty with eating foods with textures. Is it possible that the hypersensitivity developed after medical procedures involving anaesthetics, tubing, and needing medication in oral syringes?

Interview parents of children with oral hypersensitivity and also a control group of parents of children without oral sensitivity. Take a sensory history to identify if children were orally hypersensitive from birth (eg more difficulties with breast feeding, bottles etc) and also the rates of medical procedures. 

Are children who are super tasters also orally hypersensitive?

Some people are super tasters. Is there a link between taste sensitivity (super tasters) and oral motor sensitivity?

Nail Biting and Sensory Modulation

Nail biting can have a number of identified causes and solutions. Could sensory modulation work as an intervention? 

People who nail bite could be interviewed to identify if nail biting provides them with oral input, pain input, or other sensory input. Then alternative strategies for sensory input could be explored. These may be similar eg replacing oral input with another oral input? Or perhaps different sensory input eg do warm sensations, cool sensations, vibration or deep pressure sensations work to provide sensory input and decrease the need for nail biting? 

Using the dive reflex prior to an exam to decrease anxiety.

Many students experience anxiety prior to an exam. One option for decreasing the physiological impact of anxiety is to use cool water and breath holding to invoke the dive reflex. (eg cold water in zip lock bags and held over the eyes whilst breath holding). 

Fibromyalgia and light and deep touch.

We have had clinical experience with two clients with fibromyalgia who were sensitive to deep touch, and found light touch calming. Does this occur with other people with fibromyalgia?

Cleaning toilets with scent sensitivity. 

Some clients with scent sensitivity have difficulty cleaning toilets or other cleaning tasks. What strategies are the most useful for them to be able to complete this task?

Strategies for people who have sensory sensitivities and are in open plan offices

Several clients have had difficulties with misophonia or scent sensitivity or sound sensitivity within an open plan office. Research could be completed to identify the most useful strategies for coping with this. 

Intense Sensations and self-harming.

In the Sensory Modulation Resource Manual*, there is a worksheet with additional intense sensations to those traditionally used within DBT. Which of those intense sensations tend to be most useful for those with urges to self-harm?

5 strategies series.

In the Sensory Modulation Resource Manual*, there is a short list of 5 strategies to trial for symptoms including anxiety, agitation, hallucinations, etc. Research could be conducted to trial these in different clinical populations.

Reference:

"Sensory Modulation Resource Manual" (2018), J O' Sullivan and C Fitzgibbon

Sensory Modulation

Sensory Modulation can be used to change how you feel through using your senses. Sometimes Sensory Modulation is described as useful for calming and alerting but it can be used a lot more widely than this. We have made an infographic to show simply what it can be used for:

Using the scent of a loved one or scent of a loved place to provide feelings of calm.

Using the scent of a loved one or scent of a loved place to provide feelings of calm.

When there is a new puppy in the house, a common strategy is to put a cloth of the owners near the puppy, so that the puppy can smell it and feel safe. It is also common with human babies to use the scent of mum or breast milk to keep the baby feeling safe. This blog is about exploring using this strategy with older children and adults also.

The first step in using scent, is to identify the scent that reminds them of the loved one. For parents of children, a useful strategy can be for you to sleep with several handkerchiefs, or an old t-shirt. Then give your child that item to sleep with. This may be useful to try with younger children with separation anxiety on going to school.

Adults with anxiety sometimes use the handkerchief technique as well to use the scent of their partner to calm them when they are out. Other clients use scents that remind them of the individual instead. This could include:

• deodorant

• perfume or cologne

• hair shampoo or conditioner

• hand cream

• particular soap

• laundry detergent

• particular foods (eg cumin, lemons, garlic )

• garden plants eg tea tree, roses.

Once the scent is identified, then put the scent into a small bottle, zip lock bag or onto a handkerchief. Smell the item when feeling anxious or needing to feel safe.

For some individuals, there is a preference to identify the scents of a safe place or happy location. I have known clients who have used:

• sand to remind them of the ocean

• books to remind them of the library

• gum nuts to remind them of the bush.

The scents of a loved one or loved place have a very quick association with memory and with the social safety system. Using a scent can turn off the 'flight and fight' system or danger part of the brain. Feeling safe can really help us to relax and then be able to go about our daily lives.

" By increasing smell input such as by smelling the perfume of a loved one, we can activate an immediate pathway to the limbic system. Smell is the only sense that does not travel through the brain stem first, and it has  a strong and fast connection to positive or negative memories.

" Sensory Modulation Resource Manual" (2018) O'Sulllivan, J. & Fitzgibbon, C

"Aroma's work their therapeutic magic by evoking a learned association in the smeller"

The scent of desire: discovering our enigmatic sense of smell)

(2007), Herz, R. S.

.

Sensory Modulation video for anger strategies

We have made a short video on sensory modulation. This has some quick strategies that can work for anger.

Sensory Room or Sensational Zones?

 

Designing or renovating sensational spaces

Sensory rooms are designated for the use of sensory modulation equipment. These are being increasingly used on inpatient mental health units, schools and for people with intellectual disability and autism. Equipment often includes massage chairs, weighted blankets and calming lighting and videos (Champagne, 2006).In planning a sensory room, consideration should be given to how it will be accessed by those who need it when they are distressed or agitated. Some sensory rooms are locked or require clinician supervision, and this can slow down the time to access it.

Developing sensory zones within the sensory space

Within every environment, whether indoors or outdoors, opportunities exist for sensory modulation or possibly sensory overload. One design solution is to develop a distinct sensory space or zone within the unit, centre, house or school. Even within the one room, there can be smaller zones. There are more ideas for zones than can fit into one space! Spaces can be designed so that people are able to move to the area that suits their unique sensory preferences and needs at the time.

Zones may include the following:

• ·         exercise zone or gym

• ·         calm garden zone

• ·         massage zone

• ·         low stimulation zone

• ·         inspiring or creative zone

• ·         music or auditory zone

• ·         TV or video zone

• ·         eating zone

• ·         socialising zone

• ·         soothing or comfort zone

• ·         pet or therapeutic animal zone

• ·         waking or pacing zone

• ·         scent exploration zone

• ·         reading zone

• ·         icy zone

• ·         game zone

• ·         family zone (for visiting parents or children)

• ·         sensory modulation items zone.

More information is available in the Sensory Modulation Resource Manual ebook. This includes information on how to get started using sensory modulation and a list of sensory equipment items.

https://www.amazon.com.au/Sensory-Modulation-Carolyn-Fitzgibbon-Sullivan-ebook/dp/B0791WJZ5N

A print version will be available soon.

More ideas are available at:

https://www.pinterest.com.au/SensoryMod/

Coping after codeine

In Australia, new legislation has come in to restrict codeine from being able to be sold as an over the counter medication. This is due to a large number of people who have overused or become addicted to codeine. After the medically supervised withdrawal from codeine, we have had clients who have asked for Sensory Modulation strategies to assist them. Many of the clients that we see are using Codeine to feel calm or numb from intense emotional feelings. Other people use codeine to manage pain, but today we will focus on the numb and calm strategies.

Change how you feel: feeling numb

People who experience intense and overwhelming emotions sometimes want to feel numb from their emotional pain. The numb feeling has been described as thinking less, or not feeling the emotion (including the physiology of the emotion). Some people identify that they use substances such as codeine or alcohol to feel numb. These strategies can be used as an alternative to using substances or to create a feeling of numbness:

1. Changing temperatures:

• alternating cold showers with warm showers

• immerse self in or rub icy water over body and then have a warm bath

• go under a waterfall, ice bucket challenge

2. Humming Breath:

• put ear plugs in, or hold fingers over ears to close them. Then hum loudly on the breath out. This will provide a vibration feeling around the sinus area

3. Spinning

• spin around in circles

• go on a roundabout or other playground equipment

4. Lengthy intense exercise

• dance wildly

• run for a long time

5. Other intense sensations

• Suck a lemon, smell aniseed, suck a warhead, apply a heavy facial etc.

Check: Are the strategies SAIM? Safe, Appropriate, Individualised, Meaningful?

What is Sensory Modulation?

Sensory modulation is ‘changing how you feel through using your senses’. The senses include touch, movement taste, smell, sight and sound. Depending on the type of sensory input and our unique preferences, sensory modulation can increases feelings of calm, energy, improve focus and enhance feelings of safety and connection. More information available in  “Sensory Modulation” Resource Manual (2018) Julie O’Sullivan and Carolyn Fitzgibbon ebook (Amazon)

More sensory modulation strategies are available in the Sensory Modulation Resource Manual available on kindle

Using Sensory Modulation so that it is Safe, Appropriate, Individualised, Meaningful (SAIM).

Sensory Modulation can be used to change how a person feels through using their senses. This includes any items, activities, environments or that use sensory input. To give you some ideas, these are some examples:

• using a rocking chair with an agitated person with dementia to assist them to calm.

• sitting a pet on your lap when feeling sad

• splashing  face with cold water when angry

• walking in the bush to feel less stressed

As there are so many possible options, it is useful to ensure that Sensory Modulation is:

• Safe: emotionally and physically

• Appropriate: age, gender, culture, identity, environment, and affordability

• Individualised: tailored to unique preferences

• Meaningful: does the person know why it is being offered? Does it make sense to them?

A way to remember this guideline is SAIM.

Safe

Sensory modulation needs to be beneficial for the person using it and this includes being emotionally and physically safe.

Emotional safety means that clients need to feel that using sensory modulation is not traumatising, triggering, demeaning or punitive. A sensation may be ‘safe’ for one person but ‘noxious’ for another. Many people are aware of the sensations they find aversive.

Physical safety considerations including not causing injury or allergy to the person or other people.

Appropriate

Considerations for whether sensory modulation is appropriate, include the following

Age

An appropriate sensory item for an adolescent is different to an appropriate sensory item for an adult or an elderly person. Some sensory modulation items are childish looking and can result in a person feeling embarrassed or insulted.

Gender

Some clients may feel that an item should only be used by a particular gender.

Culture and identity

Cultural considerations include religious, political, race and other belief systems.

Environment

Consider privacy, noise levels, sunlight, insects and access. What is appropriate in one environment may not necessarily be appropriate in another: for example, a lounge room versus a workplace.

Affordable

In a hospital or medical environment, sensory modulation equipment may need to be durable and therefore more expensive. However, cheaper and more affordable substitutions should be available. It is important that a person can afford a sensory item if they find that it works for them, particularly so they can use such items at home. A range of low-cost options should be considered, including items found at dollar shops and op shops, and items that can be made. Sensory modulation can also occur without purchasing any equipment, through using everyday household items, natural settings and free parks and gym equipment.Innovative and inexpensive ways of making your own sensory modulation equipment are also available, with many great ideas available on the internet, Pinterest and you tube. (For example, https://au.pinterest.com/SensoryMod/)

Individualised

Each person will have different sensory modulation strategies that work for them. This is due to differences in the following:

• sensory processing

• past experiences

• individual meaning attached to a particular item

• current mood.

Meaningful

Orientation to the purpose of sensory items is crucial for them to be meaningful. Without context, asking someone to put a weighted pillow on their lap or dunk their head in icy water could be perceived as quite strange!

Sensory modulation is more effective when incorporated into daily occupations such as work, study, leisure , housekeeping, and self-care. A person is more likely to use sensory modulation if it becomes a routine in daily life, or if they use it while engaging in another activity.

We hope that using the SAIM guideline assists you with using Sensory Modulation. There are more details on using Sensory Modulation and SAIM in the book "Sensory Modulation Resource Manual"(2018).

Developing new leisure, interest or sports activities

We all like to do different things with our spare time. Sometimes it can be difficult to think of what you may like to do.  This is common if we retire, or suddenly have more spare time, or if we are depressed and need to create more positive activities in our life. We have provided a link in this blog which lists a lot of leisure interests and sports that you may be interested in. Have a look through this list and think about what interests that you may like to explore. There are some common interests and also some very unusual ones! The leisure interests are categorised through different types of sensory input as well as inside and outside options.

LISTS

Reducing Seclusion and Restraint though using Sensory Modulation

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In Australia, there is a National Policy to reduce Seclusion and Restraint in Mental Health Services.

Sensory Modulation has been recommended as one of the strategies to assist with reducing and eliminating seclusion and restraint. We are often asked how this would work.

Ideally, sensory modulation items would be available and easily accessible in mental health units and nursing homes. This would mean that if someone started to becomes distressed, agitated or angry, they would be able to easily use one of the available sensory modulation items. This could assist them to calm down. This can include items such as ice gel packs, weighted cushions, warm blankets or wraps, weights or exercise machines. Having these items in some environments requires a balancing of the benefits of having something that can calm someone down vs the risks of having these items on the units. In some places, sensory modulation items are only available in a room or at the nursing station. This then means that an agitated or angry person requires support to access the items or the room when they need it, in a timely manner. At Sensory Modulation Brisbane, we have a preference for sensory modulation items and calming activities to be generally available in units so that the person can easily access it when they need it. Some items (eg weighted items) require additional training or information from an Occupational Therapist.

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Using cold to calm

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It is starting to get warm in Brisbane so using heat packs and hot water bottles isn't really what we want anymore. This month we have been trying some new icy sensory items. This has included slushies, eye shades that can be frozen and cold squeeze balls. These items have been really popular and have been reported to help with grounding and also with anxiety. Another option is to wet a towel and wrap it around the shoulders. This helps to cool down and the weight of it also has a calming effect. There are more products on the market that can be bought but it is also possible to make your own cold sensory item. Try putting sensory items in the fridge or freezer. We have tried stress balls and smooth stones and have also frozen grapes. Cold is an intense sensation but one that can be used to change the mood. Just make sure that you don't give yourself a freezer burn!

Co-regulation

Happy New Year. Hopefully you have had an enjoyable holiday. If you are like most people then you will have had some pleasant moments and some more difficult moments. One of the things that can help when emotions are high is co-regulation. To co-regulate means that you do something to calm both yourself and someone else down. These are some ideas for co-regulation:

• Turn some music on that will change the mood. This is particularly good in the car.

• A parent can push a child on a swing. The swinging will calm the child down, and the parent can calm down whilst pushing. There are also some swings built for parents and child.

• Pour cold water for everyone to drink

• Give the other person a hug!

• Place a heavy blanket over all of the upset people. This option is better when it is cool!

There are lots of different ideas. I am sure that you will think of something that can be calming for everyone in your family.

One thing that some people are concerned about with co-regulation is that you may be "nurturing" someone when they have behaved badly. However it is important that an individual learns how to calm down and with co-regulation you are assisting them to learn that there are ways to calm down. Learning the skill of calming down will mean that the person is less likely to engage in the poor behaviour. Punishment is a much less effective strategy in assisting the person to learn new skills to cope with their emotions.

Sensory Processing or a Medical Issue?

A person may come to an Occupational Therapist seeking information on their Sensory Preferences. They may want to know if they are sensitive to visual input or seeking of movement or strategies to manage their sensations. An Occupational Therapist can provide assistance with this information by using assessment measures such as Winnie Dunn's Adolescent/Adult Sensory Profile. 

Sometimes when we are discussing Sensory Preferences, we work out that the sensitivity to sensory stimuli has only been for a short period of time. This can indicate an underlying medical condition including physical or mental health issue. An Occupational Therapist will often refer a person back to their Doctor or another health practitioner to assist with this.

Some of the medical conditions that can be confused with a sensory processing issue include tinnitus, hyperacusis, glaucoma and post traumatic stress disorder.

It is worthwhile to speak to an Occupational Therapist to understand your senses, your preferences and to assist in the process of identifying underlying medical conditions.

Dementia and Sensory Interventions

Some clients with dementia experience agitation. This may include pacing or wringing hands.

An Occupational Therapist taking a Sensory Approach would observe the client with dementia and tailor specific sensory interventions to assist. This may include suggesting that the client rocks in a chair or strokes a dog on their lap. Environmental changes may also be useful such as an outdoor walking area in a large garden.

A recent review of successful interventions for dementia found that Sensory Interventions were very useful at reducing agitation and clinically significant symptoms.

Reference:

Livingston G, Kelly L, Lewis-Holmes E, Baio G, Morris S, Patel N, et al.A systematic review of the clinical effectiveness and cost-effectiveness of sensory, psychological and behavioural interventions for managing agitation in older adults with dementia. Health Technol Assess 2014;18(39)