Dwellness™ • Input for All Senses

Input for All Senses

Dwellness™ customization for:

Your Patient

Home Environment
Home Environment

General Principles

[NOTE: Throughout the day, for each activity, try to incorporate more than one sense. For example, when your patient is listening to music encourage your patient to touch things around your patient or play with your hands… clapping, counting fingers, etc. Remember also the need for proprioceptive input, and vestibular input. Include explanation of interoception. See references at the end of this document.]
[NOTE: Every one of our senses relates directly to every other sense. When you work with one sense, keep in mind how it might be affecting all the others.]

Use Your Senses

[NOTE: The efficacy of your sensory interactions and procedures with your patient will rely mostly on your own sensory status.]

At all times, use all your senses for observations that can help you make decisions about what’s best to do for your patient's care and well-being. Always look patiently and carefully at every aspect of your patient's facial expressions, body language, arm and hand position, leg motion, and your patient's eyes. Always listen carefully and patiently to your patient's voice tone, your patient's language, your patient's silence, and your patient's breathing. Always reach out and feel for your patient's temperature, your patient's tension, and your patient's calmness or stress. Keep your sense of smell open to detecting your patient's possible incontinence (which can cause discomfort) and any irritants in your patient's environment.

Interact with Your Patient's Senses

Hearing/Vestibular

[NOTE: Your patient has a cortical hearing loss in the left ear. It’s generally agreed that your patient can hear in the left ear, but it is very different from how your patient hears in your patient's right ear, and how we hear. Remember also that hearing is not just acquisition of information, but is key to our vestibular sense.]

  • Volume
    • Keep volumes of music, online contacts, phone calls, or other audio about 30% higher than what you might consider normal listening volume
  • Direction of sound
    • For "normal" volume, work bilaterally — both sides equally
    • For quieter or more subtle sounds (quiet music, whispers, etc.) try to focus on the right ear
    • Sound is one way of knowing where you are and what’s around you: "Echolocation"
  • Startle reflex
    • Unexpected loud noises can startle your patient easily
    • The startle reflex can sometimes triggering a seizure
    • See also: "Seizure Monitoring"
    • Approach all sound as a tool for your patient's care
Touch/Proprioception/Vestibular

[NOTE: Touch has always been a challenge to your patient's sensory integration. Your patient has a very good interest in touching and feeling things around your patient, interacting with people through touch, and using this hands for activities. Some issues arise when your patient has the opportunity to touch hair, or when your patient has some discomfort in your patient's gut.]

  • Tactile exploration
    • Always try to involve tactile input when possible
    • Talk about what your patient is touching
      • Explain
      • Encourage
    • Involve your patient's touch with what you are doing, for example:
      • Changing batteries in your patient's toys, your patient loves to touch the batteries and parts
      • Musical instruments — harmonica, trumpet, drums, drum machine…
  • Tactile sensory integration problem: Chewing on hands
    • Your patient has a problem that your patient chews on your patient's hands
      • Need for sensory input to the hands
      • Expression of discomfort or disorientation
      • Need for sensory input to the mouth
      • Your patient gets no oral sensory input because your patient can’t eat or chew
    • Your patient almost always wears long-sleeve shirts with stretch fabric
    • If your patient chews on your patient's hands excessively, take these steps
      1. Stretch the sleeve out
      2. Tie the sleeve around the middle of a bandanna
      3. Use the smallest possible tip of the sleeve to tie it, so your patient has as much room inside the sleeve for your patient's hand as possible
      4. Be sure your patient's hands are not constricted — your patient is able to do normal touch activities when your patient's sleeves are tied
  • Haptic activity
    • Consistently present your patient with your patient's favorite haptic activities
      • Drum machine
      • Stuffed talking animals
      • Music keyboard
Vision/Blindness/Light Sensations

[NOTE: As your patient was losing your patient's vision, we practiced vision rehabilitation prescribed by Phillips Eye Institute. Because of this therapy, your patient still has some general sensation of light with your patient's right eye. See Instructions for more information.]

  • Flash stimulus
  • General lighting
    • Always try to keep the general lighting at levels higher than you normally would

Taste/Oral Senses

→ CAUTION: Become familiar with "silent aspiration". Your patient can eat and aspirate your patient's food without showing any signs of aspiration, due to the sensory deficit in your patient's pharynx. ←


[NOTE: Before MEB took away your patient's ability to eat, your patient used to eat by mouth normally. Throughout this process, we have continued to give your patient very small sips of water and very small tastes of foods that do not coat your patient's oral tissues.]

  • Water sips
    • Intended to help keep your patient's oral tissues moist and healthy
    • Helps encourage maintenance of any swallowing abilities
    • Procedure (NOTE: Your patient must be in a secure chair — Rifton or wheelchair)
      1. Put water in a small glass, less than half full
      2. Hold the back of your patient's head forward so your patient's neck is straight
      3. Place the rim of the glass on your patient's lower lip and tell your patient, "Here’s a sip."
      4. When your patient closes your patient's upper lip on the glass, let your patient take just one small sip and remove the glass
      5. Keep your patient's head upright until you hear your patient swallow
      6. Offer another sip — if your patient turns away, then your patient is done
  • Tastes of food

    • → CAUTION: If your patient is showing signs of congestion in your patient's pharynx, do not give your patient tastes of food. ←


    • Intended to provide sensory input and a feeling of well-being
    • Do not use any foods that tend to coat the oral tissues (dairy, oils, sticky foods, etc.)
    • Recommended: sorbet (naturally non-dairy)
      1. With a small spoon, scoop a very small amount of sorbet
      2. Tell your patient, "Here’s a taste."
      3. When your patient opens your patient's mouth, place the spoon at the front of your patient's tongue
      4. Your patient will close your patient's mouth and let the taste go over your patient's tongue
      5. Repeat for a moderate amount of time, keeping the total to a minimum
      6. Be sure that your patient's breathing is clear, your patient's voice is not gurgling, and your patient does not cough
Sense of smell

[NOTE: In general, try to keep your patient's environment free from unpleasant odors. Just as important is to keep as many pleasant odors in your patient's environment every day.]

  • Use only non-toxic cleaning supplies
    • Surface sprays
    • Carpet cleaners
    • Bathroom disinfectants
    • Laundry detergents
    • Dish soaps
    • Body soaps
    • Shampoos
  • Control unpleasant/unhealthy odors
    • Always bag up any soiled briefs and supplies in the bathroom
    • Dispose of soiled briefs and supplies ONLY in the bathroom — not any other room
    • Spray surfaces with non-toxic surface sprays
    • Use pure essential oils to make home air fresheners
    • When changing briefs, put a few drops of essential oils on the baby wipes
      • Much of the urine smell is retained by body hair, so be sure to wipe any body hair with the essential oil treated wipes
  • Freshen the air
    • Mix sprays from essential oils
      1. Use a 4-oz, empty spray bottle
      2. Put a total of 80 drops of the essential oil into the spray bottle
        • 20 drops per ounce of water
      3. Fill the spray bottle with 4 ounces of distilled water
      4. Before spraying, always shake the spray bottle
  • Foods
    • If you are cooking or microwaving at home, be aware of the odors
    • Avoid the unpleasant odors and emphasize the pleasant ones

References

[NOTE: These references are for a general introduction to sensory integration, proprioception, vestibular input, and interoception. These are fascinating fields of study, and I recommend you continue to explore more information.]


HPCA Input

Dwellness input from HPCA and family caregivers can serve to improve the ongoing support system. Feel free to speak up!