By Jackie Pool, QCS, Dementia Care Champion
This article, the second in a series of four, looks at how carers and activity providers can achieve and maintain a sense of wellbeing for individuals living with moderate to severe dementia. The focus is centred on how to support a person at the Sensory level as defined by the QCS PAL instrument.
In any care setting it is important to create an environment that helps a person achieve their optimum level. To do this, we focus on abilities, what individuals can do, and not only what their challenges are. As explained in the first part of this series, the PAL Instrument is a widely used framework in care settings across the UK and around the world, that supports a strengths-based approach, using a series of questions that define the functional and cognitive ability of the individual at four different levels: Planned, Exploratory, Sensory and Reflex.
The previous article looked at people at the Reflex level, who mainly respond to stimuli through their reflex zones. This article in the series looks at those who are at a PAL Sensory level of ability. They are likely to be living with moderate to advanced symptoms of dementia.
At this Sensory level, the person is concerned with sensations and moves their body in response to those sensations. This is a higher level of ability than the reflex response of people with very advanced dementia. A person at a Sensory level might not have many thoughts or ideas of planning or carrying out the steps of an activity or seeking a connection with somebody. But they are able to respond to sensations such as touch, taste, sounds, visuals, smells and the sensory feedback in joints and tendons from movement. This means that caregivers must facilitate the person to experience their world through the full range of their sensory modalities, spending time to draw the person’s attention to the sensory experience and using their person-centred relationship to enjoy those sensations together
It is likely that a person at the Sensory level of ability will be unable to complete complex tasks. The onus is on care partners therefore to really understand an activity, break it down into simple steps and offer multi-sensory experiences and support one step at a time.
Putting on a cardigan, for example, is quite a complex task when you boil it down. You have to recognise the garment and which is the right way round, take hold of it, pass each arm other through the sleeves while manoeuvring the garment across the shoulders and finally do the buttons up.
To promote a sense of wellbeing with this more complicated type of activity, you need a single step approach. You might start by enjoying the touch of the wool fabric, admiring the colour or, inhaling the fresh laundry smell. You might also complete some of the steps for the person, while using encouraging communication techniques such as simple action words and a warm tone of voice. The person can complete a finishing touch such as doing up the last button or admiring themselves in the mirror when their cardigan is on. That way, they experience both the sensory component of the activity as well as a real sense of achievement.
Creating a multi-sensory environment is important at this level. To achieve this, we draw on sensory integration techniques, bringing the experience of different sensations together into a whole.
For example, if you are trying to stimulate someone to be more alert in the dining room, play some music with a fast beat, make sure the food on a person’s plate is colourful and use a bright yellow tablecloth.
On the other hand, if somebody is showing signs of anxiety, try a combination of calming sensory experiences. Play relaxing music or perhaps a recording of bird song, use lavender scents perhaps with a soothing hand massage, and sit with the person in a quiet area that is decorated in calming colours and simple patterns.
When it comes to activities, ensure there is physical contact between the activity objects and the person. For example, when dining, put a fork or spoon into their hands so they can feel it. This may stimulate a reaction whereby they move the cutlery and eat by themselves.
If it doesn’t, then the ‘hand under hand’ technique might help. This is when the carer puts their hand under the person’s to guide them, for example, raising their hand to their mouth. This not only stimulates a tactile sensation but also a kinesthetics one, with sensory feedback from the shoulder, elbow, wrist and hand joints. The initial movement may act as a trigger for the individual, providing a sensory cue to help them continue with the activity.
Using reassuring sensory objects is helpful in creating a sense of comfort, safety and belonging. For example, HUG, a comforting device designed to be cuddled, includes a beating heart and a music player within its soft body. It provides an effective vehicle for a carer to connect better with a person, and to ensure a rewarding experience for both.
If not HUG, an old teddy bear, or a comfort blanket, can be almost as effective. What’s essential is that the object is important to the person and that it provides a sense of attachment. But sensory objects can also be used to stimulate alertness. Highly textured objects such as pine cones, for instance, can be great for exploration through touch.
The PAL Guide for the Sensory level of ability provides a number of ideas for carers to stimulate the five senses as well as suggestions that focus more on movement. These include single step activities such as wiping the table, winding balls of wool or sweeping outside. If the person has good balance and mobility, then gentle movements to music with the care giver are a good vehicle for therapeutic interaction. These can be standing or seated, depending on the physical ability of the individual.
What’s key is that the activity must be something that the person would enjoy. Knowing an individual’s life history enables a carer to document the individual’s past, their character, personality, career, home life and interests. By accessing this information and presenting the activity at the just right level for the person, the care giver will be able to deliver a truly individually tailored experience of multi-sensory activities that promote wellbeing.
Download your free digital copy of the PAL Instrument here: www.qcs.co.uk/digital-pool-activity-level-pal-instrument/