A kaleidoscope dances wildly with colorful, psychedelic lights across the ceiling of a darkened room. Slithering objects are projected onto a wall, a sea of lava bubbles stands tall in illuminated towers and strands of multicolored fiber optic lights sprout from a chandelier above the waterbed.

This is not the decor of a trendy new nightclub. Instead, it’s a description of a “multi-sensory environment,” used to meet various sensory needs, relax patients and even reduce maladaptive behaviors.

Thomas Marshall, vice president of sales at the Pittsburgh area-based TFH USA, recently installed this particular multi-sensory environment at the Don Guanella School in Springfield, Pa.

Don Guanella is a residential facility for young men and boys up to the age of 21 with a primary diagnosis of mental retardation and secondary diagnoses of other developmental impairments.

The room used for the installment was previously a staff lounge. The space is 12.5 feet by 18 feet with two exterior windows and one entrance door. The windows were covered with specially designed curtains to block out all light, and the room was painted white to provide a good background for the projector’s images. A few electrical outlets were added to the walls and above the ceiling to accommodate projectors and fiber optic waterfalls.

These efforts created an environment that now provides stimulation for sounds, sights, smells, feelings as well as vestibular and proprioceptive senses.

“In other places, the resident is asked do a specific task or meet a specific goal,” explains Marshall. “In the multi-sensory room, the resident is given the opportunity to explore on his own and seek out the type of stimulation he needs during that session. While caregivers must always be present in the room, they are used to facilitate, rather than direct, activities for the residents.”

Setting Is Everything

Besides residential settings such as Don Guanella, Marshall has designed rooms for nursing homes with a significant population of people with Alzheimer’s disease or dementia, public and private schools, vocational training centers, hospitals, private homes and group homes.

Ted Cookinham, COTA/L, product marketer with the Dayton, Ohio-based Southpaw Enterprises, says implementing multi-sensory products and toys into a care plan can differ depending upon the setting. Treatment plans for the three main settings – clinic, school and home – vary as each setting presents a unique set of guidelines.

For example, a clinic may use the sensory toy to develop strength to improve a child’s grasp and utilize a feeding utensil, whereas the school-based OT may use the same sensory toy to prevent a behavior from escalating. And remember, each child is unique. “A toy we may use with one child may exhibit a negative response with another child,” says Cookinham.

But regardless of the setting, multi-sensory environments can offer greater flexibility in meeting patient needs. “Some of the residents displayed maladaptive behaviors due to their sensory processing disorders,” says Marshall. “The multi-sensory room was designed to meet their sensory needs and, hopefully, reduce their maladaptive behaviors.”

Enter, Interactivity

Proponents of the multi-sensory approach say it is particularly helpful in instructing people with cerebral palsy, muscle tension, autism as well as those affected by sensory overload and who overreact, sometimes violently, to the lightest of touches.

Interactive activities include changing colors of lights, turning the fiber optics on and off, controlling bubble columns and changing images on the projectors. The ladder lights and traveling light tube are sound sensitive and are designed to provide a feedback of light when vocalizations are made. The light feedback can be adjusted, fast or slow or different colors, to provide a variety of activities.

For relaxation, there is a waterbed that warms the body and relaxes the resident before exercise of muscles and joints. An anti-gravity chair reclines to a position that places a person’s ankles above their heart, Marshall says, and this is especially good for wheelchair-bound patients. For those seeking appropriate vestibular feedback, a leaf chair was used. Marshall says this design offers a comfortable lounge chair suspended by a chain from a specially designed stand. “The relaxing nature of the room helps to calm the client and allows them to focus their attention on new tasks,” adds Marshall.

The relaxing, or “calming effect” as Cookinham calls it, can actually be a preventative measure, too. “I always tried to make my teachers aware of cueing into signals a child may be exhibiting, then redirect the child to a calming activity,” he says. “Practice the art of prevention verses escalated behavior management.”

Another benefit is that it allows many disabled clients “to do self-initiated exploration” and seek out the activities with which they feel comfortable.

“Because most [residents at Don Guanella] have a sensory processing disorder, they seek out things in the room to help them overcome their disability,” says Marshall. “The rooms are designed to provide things that help them relax, provide stimulation, as well as provide the opportunity for them to interact with the equipment and demonstrate cause and effect.”

Offering an Escape from Physical Limitations

These interactive pieces of equipment help therapists show cause and effect, reduce maladaptive behaviors and relax the patients. It’s also important to note that the multi-sensory approach applies to all types of patients, regardless of physical limitations. For example, Marshall says, special measures were made so that patients with physical limitations could manipulate elements such as switches.

These special measures give patients a sense of normalcy and confidence, which can be integral to rehabilitation or mentally coping with a condition. Increasingly more play therapy toys are being released to celebrate the differences and the challenges of special needs children. Case in point, East Greenwich, R.I.-based Sew Dolling recently launched a new line of nine vinyl dolls with above-the-knee or below-the-knee amputations and three dolls without hair.

“Play therapy is extremely important to help children build their sense of self worth,” says Susan Svendsen, owner of Sew Dolling. “A child may long to meet or play with others who look like they do, but this is not always possible. These dolls are offered as a supplement to help a special needs child in their journey.”

The dolls come with several physical therapy accessories – including wheelchairs, parallel bars, mats and therapy balls – allowing the child’s doll to progress along with their owner. The dolls without hair come with a wig and a bandana, slouch hat or baseball cap.

Considerations in Play

There are many factors a therapist should take into account when considering the option of play therapy. First and foremost: cost.

Marshall says the one room installation he completed at Don Guanella, including full installation and training of all of the staff that will be using the room, was a little more than $17,000. This price does not include additional expenditures for electrical adjustments or the addition of a new door.

While Don Guanella’s multi-sensory environment is one of the most cutting-edge options on the market for targeting developmental concerns, stimulating and calming children, $17,000 might not fit into every budget. But don’t fret; there are other options.

For instance, horticultural therapy and pet therapy programs at St. Louis Children's Hospital are well established and integrated into formalized therapy programs. And just recently, the institution added music and art therapy programs. These options are less expensive and still encourage healing through a multi-sensory approach.

Another consideration is the mobility of multi-sensory products. Don Guanella’s patients are also residents and having a room on-site is very beneficial. But it’s a different story for highly mobile, traveling therapists or school-based therapists without a stationary room to dedicate to a multi-sensory environment.

Therefore, mobile therapists should look for mobile products such as Southpaw Enterprises’ Deltasand, a multi-sensory product that acts and feels like wet sand while having a calming and organizing effect to the body. It comes in a lightweight blow-up tray so it can be transported in situations such as a school-based therapist going from school to school.

Entering a New Era

According to Cookinham, multi-sensory products and play therapy are part of a larger shift in the field. “We are all experiencing the evolution of a new era,” he says, “which includes youthful and exuberant teachers who have heard about and are being introduced to sensory integration long before they step into a classroom.”

As for forward-looking thoughts, Cookinham says a multi-sensory toy that can be used as a cross-curriculum tool is in its early stages. “The future is wide open,” he proclaims.

And as the momentum builds in the therapy arena, colleagues and proprietors are hopping on the bandwagon, too. “I feel that since the very beginning occupational therapists have used multi-sensory toys and [it’s] always been commonplace,” says Cookinham. “The key element is that administrators and teachers, especially today, are recognizing the benefits and implementing the use of multi sensory toys as learning tools into the classroom much more.”

Amy Storer is the senior managing editor of Therapy Times. Questions or comments can be directed to editorial@TherapyTimes.com.