Sundowning is a term broadly used to describe a set of behaviours occurring in people with or without dementia, which commonly presents later in the afternoon, evening and late at night. Behaviours include confusion, disorientation, anxiety, agitation, yelling and calling out, aggressive outbursts (verbal and/or physical), pacing and wandering.
While not a formal psychiatric diagnosis, the prevalence of sundowning is well recognised and well documented. Some literature suggests rates of sundowning for elderly persons with cognitive impairment such as dementia are as high as 66%. Sundowning can be very challenging to manage and have a significant impact on the person and their loved ones/carers who are supporting them.
Read moreRecently I met with one of the most experienced and skilled Mental Health Clinical Nurses in Queensland – Rachel Woolcock. Rachel has over 20 years’ experience with Mental Health including acute care and homeless health. Rachel has undertaken Sensory Modulation Brisbane training and applies Sensory Modulation strategies regularly when working with very distressed or agitated clients. Rachel identifies that one of the most beneficial techniques for this client group has been cooling down with the dive reflex response. In her experience, Rachel has found that it is important to acknowledge that the technique sounds 'unusual' or 'a bit funny' but continues to encourage people to try it, with positive outcomes!
Read moreOccupational Therapists have a lead role working with individuals in the area of occupational performance. Occupational performance refers to how a person engages in meaningful and valued activities in their life and can include self care, daily living skills, community living skills, work, leisure and many more.
An Occupational Therapist who is assisting a person with their occupational performance will identify strengths, barriers, supports, problems and solutions to participating in occupational performance. This process often involves an observation of the person undertaking a or a select number of tasks, as well as completion of checklists and standardised assessments. From here, the OT will then identify possible interventions, with regard to the person (P), the environment (E) and the task/occupation (O), aimed to improve or assist their ability to actively engage in the activity, thus enhancing their occupational performance.
Read moreDazza* was a keen soccer player who had been having difficulties with anger and aggression which had resulted in him being sent off the field. He decided to see a Mental Health OT and they had worked out a plan together which involved using Sensory Modulation. Sensory Modulation is an intervention that uses the senses to change how someone feels. His OT had told him about the benefits of changing his feelings in the moment when he was angry by using cooling water to change the anger response in his body. Dazza had experienced a quick calm down after he poured water over his head and could really see how this could assist him with his anger.
He went to his Saturday night Soccer with his cold water bottles and his plan clear in his head. He was very motivated to reduce his anger as he did not want to be the type of person who hurt other people or made them feel uncomfortable.
Read moreSensory Modulation Brisbane often discusses the effectiveness of sensory input as a pain competitor, to more effectively manage pain and improve functioning. For example, using temperature, deep pressure or intense scent. It is understood that the application of sensory input interferes with the transmission of pain signals, thus dialling down the intensity.
Read moreWorking from home/ changes to work locations has been one of the many challenges facing individuals during COVID-19. Some people have absolutely loved this change, while others cannot wait to return to the office environment. Are these differences all to do with personality traits? Or the trend towards open office spaces? Occupational therapists would suggest that it may also reflect our diverse sensory preferences.
Read moreWeighted blankets are a popular Christmas present this year and have also been described by Time Magazine as one of the best inventions of 2018 (Source: Choice Magazine.) Gravity weighted blankets have sold over $18 US million dollars worth of weighted blankets yet many experts say that there is no evidence that they work. .
I must admit I am getting a little tired of ‘experts’ being interviewed who state that there is no evidence for weighed blankets. I wonder if they do a recent google search or if they are going on something that they read years ago when the research trials were just beginning.
It would be more accurate to describe that there is strong evidence in some areas and limited evidence in other areas. In research groups, strong and limited evidence is described according to levels of evidence. This table describes the categories of level of evidence.
Read moreSensory Modulation and the Hospital Environment
Hospital admissions can be an extremely overwhelming experience, no matter the reason or duration of the stay. A significant contributing factor to this is the experience of sensory triggers, often at heightened levels and unique to the hospital setting. This overstimulation of the senses is further compounded by the person’s difficulty in modulating the environmental input to suit their individual sensory needs due to illness or injuring, having cognitive or mental health issues, and simply not having the ability to control the environment they are inhabiting.
Read moreEveryone benefits from knowing some strategies to calm down, and it can be useful to try a few techniques to find a personal favourite. This blog is describing using cooling items to chill out or calm down.
Read moreI have been reading about using paper bags for hyperventilation that is occurring for panic. An article written by M Tavel and published in an internal medicine journal (2017 ) has recommended paper bags or breath-holding. There is no mention of any of the other breathing techniques that are commonly used in mental health practice.
Read moreA Sensory Room is a dedicated room with an array of sensory items and strategies for people to trial and use to support their development of self-management skills and to change their moods through Sensory Modulation*. Sensory rooms have been found to be useful in many mental health units by those who use them. (Champagne, 2011).
Often people express that they would like to use Sensory Modulation, but that their organisation is unable to fund a Sensory Room or find the space to put one. The good news is that is possible to use Sensory Modulation on an inpatient ward or emergency department without a Sensory Room through the use of low cost or existing sensory items or considering the environment.
Read moreSelf-care is increasingly identified as a foundation for physical and mental health and wellbeing. It can be explained as self-directed activities a person engages in with the goal of moving towards a more optimal level of health. Self-care activities involve general daily living tasks (such as healthy eating, getting enough sleep and regular exercise) and can incorporate additional self-initiated activities that may be viewed as relaxing (yoga, meditation), pampering (massage, facial, movie) or a social outlet (date night, catching up with friends).
Read moreMany teachers report having insomnia at some time throughout their career. Insomnia is the experience of difficulty getting to or staying asleep, and the subsequent sleep deprivation that results can further add to the stress a teacher already experiences.
When someone finds it difficult to sleep, they often also experience a degree of anxiety and/or stress. This is sometimes referred to as the ‘fight and flight’ response. The body changes that occur during the flight and fight response include an increase in heart rate, tense muscles, increased speed of thoughts and feeling jumpy/jittery. If these bodily changes become a pattern or habitual response to stress, it can prove more and more difficult for a person to recognise the signs of its onset. An accurate predictor of a switched on ‘fight and flight’ is when the brain feels like it is ‘active and on alert’.
Read moreSafety Tools are being found to be very useful in emergency departments and on mental health inpatient wards, as they incorporate aspects of trauma informed care and also provide some options for using sensory modulation in the hospital environment.
Safety Tools are sometimes also known as personal safety plans. Many hospitals have their own versions, developed in collaboration with consumer consultants.
Read moreHaving been a new parent, I know how hard it is to settle a baby at night who does not settle after feeding and is noticeably distressed.
As a new dad, I found this scenario to be extremely difficult to handle, especially when you are battling to stay awake due to sleep deprivation.
I would often give up attempting to settle our baby and put the experience into the “too hard” category, often relying on my partner to do the settling.
It took me some time to learn some valuable lessons about the benefits of persisting with feeling uncomfortable and embracing the experience of attempting to settle our baby during crying and screaming episodes.
I want to share what worked for me.
Read moreThe 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.
Read moreThe 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.
Read moreThe 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 on 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.
Read moreStudies 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).
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