1. ABOUT A SENSE OF CALM
"A Sense of Calm" is a pure form of relaxation therapy, presented in the convenient form of a DVD. It can help to calm anyone who is stressed, anxious, or agitated and is being successfully used as part of a holistic approach for the well-being of people living with dementia and other medical conditions, where the nature of their condition can lead to frustration, agitation, anxiety and sometimes rage.
The tempo of the moving images and music on "A Sense of Calm" have been specially created and choreographed in accordance with the scientific principles of sensory stimulation (see our section on Sensory Processing), to promote calming alpha brainwaves that act as a filter, relieving the stress caused by sensory overload.
Sensory stimulation is known to be helpful for children with learning difficulties, but it has also been found to be of great benefit for people living with dementia. The big difference being, while children are at the beginning of their learning cycle, adults living with dementia have years of experience and memories that are beginning to falter, making it difficult for them to process information, so damaged half memories and misinterpretation of sensory input start to become part of their problem.
This is why we describe “A Sense of Calm” as a pure form of relaxation, one that does not rely on learnt responses and memory association. It does not rely on the viewer's familiarity with the imagery and the music, nor does it require learnt memory responses and analytical thought processes to be effective.
Sensory rooms encompass a variety of equipment to give an all encompassing sensory experience, with sound and visuals creating a background against which other stimuli, like touch and smell can be added.
"A Sense of Calm" DVD is designed to give the same benefits of a sensory room, but with flexibility of use, so it can be used where and when it is needed, in the home, the bedroom, the living room, or in a professional health care situation, at a fraction of the cost of conventional sensory equipment.
2. USING A SENSE OF CALM
“A Sense of Calm” is a 60 minute DVD, featuring 6 specially created, relaxing videos of approximately 10 minutes each.
The images and music in each video flow seamlessly to the next, so it can be used by occupational therapists and carers for up to one hour of therapy, or in smaller segments for those who just need 10 minutes to relax to their favourite video.
"A Sense of Calm" can be viewed as a relaxation therapy in itself, or as a therapeutic means of creating a calming atmosphere that can promote social interaction and communication. It should not, however, be considered a pacifier!
During a sensory session, Occupational Therapists engage patients in purposeful activities that are individual to the patient's needs. If, however, an individual is in a high state of anxiety it will be necessary to bring about a sense of calm first, by filtering out any signs of sensory overload from the environment.
For best results, we recommend cutting down as many outside distractions as possible, by playing the DVD in a comfortable, quiet room with subdued lighting.
The music should be adjusted for the individual – not too loud, but loud enough to be heard, so it helps to create a soothing atmosphere.
In a care situation, once the relaxing influences of “A Sense of Calm” have started to take effect, the DVD can be used as a background to introducing other, controlled, stimulation in the form of massage, exercises, task-based activities, or social interaction - these will be individual to the patient's needs.
OTHER TIPS ON USING A SENSE OF CALM
If someone is in an elevated state of anxiety it is not always possible to sit them down in front of a TV screen. In these circumstances, a calming atmosphere can be achieved by playing the DVD somewhere in the room where it can take the attention of the individual, so they can gravitate towards it in their own time.
The calming effect of "A Sense of Calm" will then gradually start to take effect, which can then lead to further meaningful interaction between the individual and the carer.
Many people living with dementia become anxious when they are asked to perform certain everyday tasks, like bathing, eating and going to the toilet. A session with "A Sense of Calm" prior to undertaking these tasks can often relax an individual and make these tasks easier for them.
Having used the DVD to create a calming demeanour, other sensory stimulation techniques, social interactions and other activities can be introduced, but these must be sympathetic to the individual's sensibilities.
Because people living with dementia encounter increasing problems with memory and sensory processing, the carer should always be on the look out for signs that their actions do not cause the individual more distress, especially in the latter stages of dementia where someone might find it difficult to articulate their thoughts.
For example - if the person living with dementia once had an interest in horse racing and still derives some memory-related pleasure talking about horses, the carer should be careful to monitor the individual's reaction to memory dependent detail.
Questions like - remember when Red Rum won the National, may be upsetting because they can't, so it may be better to talk in general terms, perhaps using props, like pictures of horses, to aid the conversation. Bringing gentle humour into a conversation may also be helpful.
Again, if someone living with dementia still derives memory related pleasure from their favourite music, the volume of the non-memory-provoking music on the DVD can be turned down and the individual's favourite music can be played alongside the images on the DVD using a separate player. Equally, the DVD music can be played as a background to other visual stimuli.
The DVD is particularly useful for individuals who are in the latter stage of dementia, but because it will work on anyone, whether they have dementia or not, it can be introduced whenever someone is agitated.
In fact, the DVD is being recommended to carers and professional health workers who need to take time out to relax from what can be a very difficult and stressful vocation.
Carers may find resistance from people in the early stages of dementia to resources that are exclusively designed for dementia, so some carers introduce the DVD as a way of relaxing themselves and include the individual by inviting them to watch along with them.
The DVD can also be used in a communal lounge during times like "sun-downing," when people living with dementia can become tired and irritable towards the end of the day.
3. OTHER SENSORY TECHNIQUES
HAND MASSAGE
Hand massage can help to soothe and provide interaction with an individual, but the carer needs to be conscious of any sensitivity, swelling, or injury that may cause distress.
Hypoallergenic hand lotions are a good idea, along with a smile and a gentle touch. Make sure you are facing each other and explain in a soothing voice what you are doing.
Apply a small amount of the lotion and massage each finger in a circular motion from the base to the tip, then down again and with the palm up, make tiny, slow, circular motions in the centre of the hand, before repeating with the other hand.
If you are a home carer and have never attempted hand massage before, ask a professional carer to show you how, or look out for some simple techniques on the internet.
When you feel the individual has had enough, remove any excess lotion with the warm washcloth or towel, or in some cases cotton mittens can be comforting to soak up the lotion adding an extra tactile dimension.
AROMATHERAPY
Relaxation can also be enhanced through the sense of smell, but again personal history and the effect of potential memory-provoked distress must be taken into account if the individual has an allergy, revulsion, or unpleasant memory associated with a particular scent.
Traditionally, Lavender is said to be calming and to balance strong emotions. It is also an antidepressant and is used in cases of insomnia, so it can be used in the evening to promote better sleep.
Lemon balm also helps to calm and relax and is helpful to those suffering from anxiety and insomnia.
Memory-provoking scents like baking smells, perfumes and flowers can also be used if the individual reacts well to them.
MEMORY BOXES AND REMINISCENCE
Memory boxes are a collection of artefacts, photographs and possessions that have been collected to give an idea of the interests, lifestyle, relationships and experiences an individual has encountered throughout their life.
For professional carers, these can be useful tools with which to start a conversation and for home carers they may help as props to aid a conversation.
These should be used with care, however, as asking someone about a picture of a relative they have forgotten, or who has not visited, may cause upset and distress. They may even provoke memories of traumas that occurred when they were children that they have suppressed for years, but are suddenly at the forefront of their mind.
Also dementia is a progressive condition and an individual's perceptions and tastes may change over time. Lifelong teetotallers have been known to develop a taste for Guinness and teachers who have devoted their lives to children, can get agitated by the sight and sounds of a children's choir.
In reality, the memory box should also be a store of whatever is found to be of help here and now. But nothing should be discarded, as something from the past that an individual reacts badly to at one stage may be useful at another time.
OTHER TACTILE STIMULI
An individual may derive pleasure from a number of tactile substances like fur, popping bubble wrap, soft balls, teddy bears, dolls, activity games, wrapping paper, cushions filled with micro-beads, gel filled plastic or gently vibrating pads.
One study on sensory rooms found that 50% of the participants did not like the tactile elements, so as with all sensory stimuli; some trial and error is involved to see which are helpful and which are not to the individual.
The effect of holding hands, or a simple cuddle, must never be underestimated as a gesture of friendship and letting someone know they are not alone.
OTHER AUDIO AND VISUAL STIMULI
If an individual has reached a relaxed state where they can entertain memory-provoking stimuli, paintings, photographs, posters, picture books and other visuals can be used to aid interaction, but only if the individual can process the information without becoming distressed again.
The same is true for audio stimuli, listening to CDs, the radio, reciting nursery rhymes, or taking part in a sing-a-long.
4. SENSORY PROCESSING
Our ears, eyes, mouth, nose and sense of touch are our windows on the world. We integrate the information we collect from these senses and together with the aid of memory and stored knowledge, we respond and interact with the environment in which we find ourselves. These senses are also important factors in determining our emotions, moods and levels of stress.
Imagine one of those days where you've been running late all day, you got stuck in traffic, the DJ on the radio got on your nerves, the sun strobing through the trees gave you a headache and your clothes feel uncomfortable and sweaty? You're tired and all you want to do is go to bed, but the events of the day are still swimming through your head.
You are basically in sensory overload and you have become sensory defensive, where everything and everyone has become an irritant.
Now imagine what it must be like for someone with dementia, who is finding it increasingly difficult to cope and comprehend what is going on around them.
Because dementia is a progressive condition, carers must come to terms with the fact that the individual they are caring for is finding it increasingly difficult to integrate their senses and are undergoing a process of sensory disintegration.
Their senses may be disrupted and their memory misfiring, giving them confusing, or distressing signals in their brain, making them irritable, agitated, frustrated, demanding, physically unbalanced and sometimes aggressive.
SENSORY STIMULATION
The principles of Sensory stimulation, upon which “a Sense of Calm” is based, involve using sensory input for the purposes of calming and promoting relaxation in someone who is frustrated, anxious, agitated, or stressed by sensory overload.
No demand is made on the person, so no stressful thought processes are needed. All we are doing is filtering the environment, gently focusing attention away from other stress-making stimuli and promoting soothing alpha brainwaves, which are associated with a state of relaxation.
The fastest brain waves are beta waves, which occur during ordinary consciousness as we focus our attention and when we experience strong negative emotions.
Somewhat slower alpha waves occur during an awake, relaxed state, heightened awareness, during meditation, and just before nodding off.
Theta waves are even slower and occur during periods of peak creativity, meditation, and sleep, while delta waves, the slowest, occur during deep sleep, deep meditation and unconsciousness.
The slower the brainwaves, the more relaxed, contented, and peaceful we feel.
SENSORY THERAPY AND DEMENTIA
As we have mentioned already, Dementia is a progressive condition, so carers must be careful to adapt their approach to the needs of the individual. This means not only taking into account that individual's past likes and dislikes, but also personality changes, changes in their patterns of behaviour and new sets of circumstances where their pre-conceived likes and dislikes have changed.
For example, at some stage, someone may start to become irritated and anxious when watching his, or her, favourite TV show. This may be because they are unable to process information and follow the plot, or because they are so familiar with the character, they become confused between reality and fiction.
“A Sense of Calm” is a pure form of relaxation - because it is deliberately designed not to provoke memory, nor rely on any learnt imagery to achieve its goal.
Familiar images of real scenes, people, animals and music that evoke memories can be relaxing to some, but these stimuli rely on those memories being intact and undamaged.
Imagery of a sun kissed beach, a walk in the country, or prancing ponies may bring back happy memories for some, but for others they may bring back the horrors of being bitten by sand flies, a long forgotten childhood mishap, or simply the frustration of a corrupted memory that they can't quite recall.
It may seem natural to help someone with dementia to remember things, point out when they have asked the same question more than once, or correct their confusing view of reality, but for the person living with dementia, this can be frustrating, upsetting and annoying.
They may be living in a different world, a different reality, controlled by memories from a different time and whilst it may be difficult to pretend to validate their world, by “playing along,” a balance between their world and reality is often the kindest way to proceed.
It can be difficult, but gentle redirection, starting by accepting what they believe at the time and gently bringing them back towards reality is kinder than pointing out to someone they are wrong.
Some people will never be told they have dementia and others will forget that is why they are getting things wrong, either way, it can be distressing if someone tells them they are wrong and dementia is the reason for their confusion.
Sometimes they just need time to relax, exclude sensory overload and not worry about half formed memories, or confusing thoughts.
