Why sensory integration is important for individuals with dementia
Just about everyone has sensory needs. Whether it's an attraction to smell, material, tactile stimulation, or a predisposition to like fluffy things, all humans crave some kind of sensory input. Individuals with dementia are no different, and some of them may have more sensory needs later in life than they had previously.
In addition, dementia can affect the way in which an individual interacts with their environment. Many are scared of shadows or dark areas and have difficulty with visually cluttered or heavily patterned environments.
Sensory integration in the environment of dementia patients can help apply a holistic approach to their quality of life.
There are a plethora of ideas and practices a caregiver can do to help their patients with dementia thrive at their present levels.
Allen Cognitive Levels
Allen Cognitive Levels are used in dementia care to describe the abilities and functioning levels of patients. Occupational therapists, doctors, and the likes can use these levels to help individuals modify their routines and environments to help them best integrate into their environment.
The Allen cognitive levels are important to understand because they can help a caregiver determine what products and routines might work best based on the patient's abilities. They go as follows:
- Level 1 describes automatic actions (e.g., swallowing, diverting attention towards stimuli). In other words, Level 1 describes the patient's arousal to external cues. This cognitive level is largely instinctual behavior, and patients require total assistance with activities. A patient who is below cognitive level 1 would be in a coma.
- Level 2 describes postural actions (e.g., gross movement in response to proprioceptive cues). The driver for the patient's actions is primarily comfort or discomfort, remaining mostly unaware of the effects of their actions on their surroundings. Aimless pacing and/or wandering are observable in patients functioning at this cognitive level. Patients at Level 2 require maximum assistance.
- Level 3 describes manual actions (e.g., grasping at and using objects). What distinguishes Level 3 from Level 2 is the increased ability to discriminate the external from the self. The patient's global cognition remains impaired at this level, but long-term repetitive training can allow these patients to acquire new behaviors by better noting their effects on objects, sustaining their actions, and utilizing materials for ADLs. Despite their ability to sustain actions, patients at Level 3 still lack long-term concentration and may need frequent re-direction to complete tasks appropriately; moderate assistance is a recommendation for Level 3. 24-hour supervision should be in place for patients at Levels 1, 2, or 3.
- Level 4 describes goal-directed actions (e.g., preparing a snack, following a route around a familiar neighborhood). At this level, the patients can recognize and understand the effect their actions have on their surroundings. Relying on visible cues, they can learn and carry out activities specific to particular goals. However, patients functioning at Level 4 still have trouble recognizing finer details and learning independently. Hence, they often lack the cognitive skills to identify and fix errors, and supervision in the form of minimum assistance is the recommendation for these patients.
- Level 5 describes exploratory actions (e.g., problem-solving through trial-and-error). Patients at Level 5 of the ACLs can learn by emulation of actions shown to them. They are also able to apply what they learn to other activities and situations. Still, these patients have limited ability to organize, anticipate, and plan. This limitation can lead to poor judgment and higher impulsivity, especially in situations that require more deductive reasoning. External cues via supervision can help patients at this cognitive level plan. Patients at Level 5 should receive standby assistance.
- Level 6 describes planned actions (e.g., anticipation and prevention of errors). There is no global cognitive impairment at this level, and the patient at this ACL is considered to be a normally functioning adult. It is important to note that because the ACLs describe cognitive levels, the patient may still have physical limitations. There is no supervision required at Level 6.
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Understanding the Allen cognitive levels of an individual can help with specialized care, especially sensory-based solutions. Since the abilities of an individual at each level varies, the sensory needs also may vary.
Considerations
For individuals with dementia, Allen cognitive levels are not always linear. Some individuals who were at a 4 one day can very quickly move to a 2 with little warning. Planning care interventions for individuals with dementia at their present cognitive level with considerations for their future level is virtually necessary.
Sensory-based preferences vary from individual to individual, as well. While one person may love vibration or vibrotactile sensory items, another may prefer something more olfactory-based.
In addition, individuals who have dementia may also prefer more age-appropriate sensory solutions. There are a plethora of products for kiddos with sensory issues, and there are a plethora of products for adults with sensory issues, too.
Level-based sensory intervention care and recommendations from Emily Martin, OTR, and Lyndsey Boyer, OTR
Occupational therapists, who work with the aging population have to constantly ask themselves: what will work for now? What will work a year from now? Forward-thinking into care can be hugely beneficial in transitioning the individual into the next level.
Together, Martin and Boyer brainstormed a lot of ideas that may be able to help individuals with dementia at their present levels.
Sensory needs considerations for Levels 1 &2: Infantile stages and gross body motors
Olfactory stimulation
- Familiar scents to elicit responses (familiar lotions, aftershave, perfumes, etc.)
- Scents like lavender to decrease agitation
Tactile stimulation
- Vibration mitts
- Sensory walking path (indoors or outdoors)
Modify the home environment visually
- Different, calming wall colors, less busy wallpaper
- Minimizing how visually busy home environment is
Visual stimulation
- Fiber optic lights
Auditory stimulation
- Relaxation tapes, guided meditation, vibration noises, wind chimes, favorite songs
Sensory needs considerations for Level 3: manual actions
Replacing daily tasks with automation
Age-appropriate care
- Example: individuals who are presently in the geriatric population and are a level 3 often have difficulty brushing their teeth. A seemingly obvious answer is that electric toothbrushes work well to get people to brush their teeth. That's not such a good idea, because individuals who are in the geriatric population didn't grow up with that, so they won't know well how to use it. Try using a double-sided toothbrush instead.
Sensory needs considerations for Level 4: familiar activities
- Labeling containers of clothing or dishes
- Cameras, locks on doors, elopement prevention plans
Tactile stimulation
- Fidgets
- Personalized sensory blankets
- Weighted blanket
Vestibular motion
- Gliders
- Rocking chairs
- Stretching
- Reaching
Going forward, please note:
Please keep in mind that what might work for some might not work for all. Individuals may have a personal preference based on their sensory needs, Allen cognitive level, and age. What might work for some might not work for all.
Edited and updated February 2022 for clarity
