Parenting first gave me an appreciation of just how much sensory preferences can affect a person’s life. My son is very picky about the feel of things on his skin. Beautiful clothes that were made or bought for him when he was a toddler were never worn. He even made up his own word for the things that he chose not to wear. ‘Scruff!’ he used to shout as an item was thrown across the room. Face painting was a no-no too. We patiently queued for him to be made over. He would then demand that the artwork was washed off immediately because it felt horrible. And when he feels poorly his sensitivity of sound increases. Once he argued to be allowed to stay at home from school by gauging the noise levels in each lesson and whether he would be able to tolerate them or not.
Winnie Dunn, an occupational therapist, has suggested that there are four different sensory processing styles that are a combination of whether an individual has high or low thresholds that yield a reaction to sensory stimulation and whether they have active or passive strategies to the stimulation that they receive.
Sensory Avoider (low threshold, active management strategies): My son fits this category!
Sensory Sensitivity (low threshold, passive management strategies): Those who might have a low threshold for a response to sensory stimuli but do little to manage it actively. They might complain or be distracted easily by stimuli that other people might not notice, for example traffic noise or the smell of air freshener.
Sensory Seeking (high threshold, active management strategies): These people have a marked preference for sensory input and actively seek it out. They might, for instance, have a preference for physically active sports, wear and decorate with bright colours and like loud music and strong tastes.
Low Registration (high threshold, passive management strategies): The in this category may be unresponsive or unaware in environments where there are high levels of stimuli.
Implications for People with Dementia
Through identifying a person’s processing style their social and physical environment and activities may be tailored so that it is a good fit for them. This can be done by examining their life choices and through observation. Of course people do not fit exactly into four different boxes. In the example of my own son I’ve already identified his tolerance to noise changes when he is unwell. Other people may exhibit different styles across different senses. However Dunn’s model is a good starting point to start to explore this domain which has considerable potential to yield positive change for an individual.
For people with dementia both age related sensory loss and changes to their brain caused by the disease process may mean that a person processing style may be different to what it was in the younger years. Obvious examples where this occurs might be an increase in sensory thresholds due to sight or hearing loss. Passivity may increase because of changes at brain level. For others a sensory stimulus may elicit the same emotional response that always has. Yet a person might not be able to act in the way that they did when they were younger to manage it, perhaps because of communication, processing or motor difficulties.
Even so a person’s preferences in their younger life can often tell us much about when they might need from a sensory perspective when they have dementia. I’m reminded of the many people who seem to have been sensory seeking through their preference for very physical occupations and sports. They are often the ones who exhibit high levels of agitation and distress when physical activity is denied to them.
This is a fascinating area of intervention where my own profession of occupational therapy are taking a lead role in advancing knowledge, collating evidence and providing individual assessment and recommendations. When activities and landscapes are a good match for an individual with dementia in terms of their sensory preferences and abilities these have potential to improve well-being and engagement. A calm but alert state is the goal.