The book Sensory Modulation in Dementia Care: Assessment and Activities for Sensory-enriched Care was written by Dr Tina Champagne, an occupational therapist who is devoted to developing and building capacity for the applicability of individualised sensory-based approaches across the lifespan.
The book starts with a brief description of ageing and dementia, focusing on concerns such as restraining, trauma and meaningful engagement that are typically most relevant to sensory-based approaches. Concise summaries of challenges for those with dementia including safety, cognition, sensory acuity, sensory and motor integration and processing, sensory preferences, sensory and occupational deprivation, self, and daily functioning is presented. It is brought to the reader's attention that four of the eight challenges are in fact associated with sensory processing. The following introductory chapter on sensory process is helpful for the lay person – and even for professionals who do not have biological training – to dissolve the myths about the senses and equip the reader with a knowledge of the functions of the senses in daily human life. In particular, it provides a summary of the eight senses with regard to their corresponding receptors, primary functions and contributions. The comprehensiveness has further been enhanced by discussions of sensory integration and processing, deprivation, motor performance, discrimination and modulations. These two chapters lay down a solid knowledge base that readers need to be equipped with for further reading of the chapters on practice.
The framework and illustration of the seven core elements of the Sensory Modulation Program (SMP) are very practical, so that practitioners can use the information as a guideline to design, implement, review and reflect on sensory-based interventions. The ingredients include sensory-based assessments, activity choices, modalities and diet. The sensory diet, defined as ‘a strategically planned routine that incorporates sensory-based strategies that promote feelings of safety, comfort, and calm, and support activity participation in roles, routines, and activities’ (pp. 66–7) is very reflective and insightful for both formal and informal carers who are supporting people with dementia on a daily basis. Sensory intervention is and must go beyond half-an-hour or one-hour sessions, but also integrate with daily routines so as to fulfil the four ultimate goals under SMP.
Under the assessment and safety chapter, discussions on safety consideration and trauma history bring readers the lifecourse perspective on sensory-based intervention. Everyone has his or her own history of personal as well as generational experiences. The differentiation between calming and alerting stimulations is found to be critical for interventionists to gain a comprehensive understanding of the daily habits of people with dementia. Under these two strategies, it would be understandable that although people with dementia are treated as a group, heterogeneity should be stressed when designing any intervention. Here, it is useful to reflect again that dementia care is expected to be both personal and interpersonal. The personal aspect focuses on contextualised developmental history in regard to culture, society, community, family of origin and current family. From the interpersonal perspective, assessment and activities must be developed, facilitated and evaluated in the context of formal carers in facilities for long-term care, transitional care, acute care, rehabilitation care, day care (if possible) or a household environment including home-care team workers, family carers and the patients themselves.
In this regard, examples listed in the last three chapters on choices and varieties for sensorimotor activities, sensory-based modalities, sensory diet, and environmental modifications and enhancements are very constructive in stimulating interventionists during the planning, execution and review stages. Interventionists could take references on potential choices and options taking consideration of assessment results of a particular patient and his or her family. It is very important also to consider availability, accessibility and affordability of choices and options. For a long-term care facility service unit, it is important to reflect to what extent sensory-based assessment and intervention shall be integrated into other aspects of interventions, including physiotherapy, speech therapy, social work intervention and/or recreational interventions. It would also be essential that team members with multi-disciplinary backgrounds be equipped with knowledge of values, goals and strategies, assessment and interventions so that a common language concerning the sensory modulations could be reached. Otherwise, challenges could be encountered to what is seen as a segregation of interventions, which could have unintended consequences for the dementia patients and their families.
The Appendices on assessment and links for online resources again are very helpful, especially two reflections on applying developed assessments and intervention strategies. The first is on cultural validity. Even though dementia is a disease with a biological base, taking care of dementia patients and supporting their families is a cultural-specific task. The second reflection, on the competence of interventionists, suggests that it might be worthwhile to be cautious about capacity building of interventionists before executing interventions. For a first-time trial, a pilot would be recommended.
