The importance of utilizing multisensory environment in preschool settings

 Table of Contents

Background with supporting evidence-7

Evidence against capstone………………………………………………8

Needs Assessment………………………………………………….8-10

Linking to Occupatonal Therapy……………………………………..10-13

Theoretical Model…………………………………………………..13

Description of project………………………………………………13-18

Conclusion………………………………………………………….18

Appendix A: Needs Assessment Chart………………………………….29-36

Appendix B: Smart Cookies Draft Waiver…………………………………37

Appendix C: Teacher Education Sheet………………………………….38-40

Appendix D: Feedback Questionnaire…………………………………….41

Appendix E: Multisensory environment magazine…………………………42-46

Appendix F: Multisensory environment infographic………………………….47

Appendix G: Figures

References………………………………………………………….1

 Background with Supporting Evidence

According to the American Association of Multisensory Environments, a multisensory environment (MSE) is a dedicated space that consists of various multisensory equipment to stimulate the senses (Messuber, 2012). Multisensory equipment can consist of lights, music, tactile boards, and visual items (Maseda et al., 2014). MSE was first developed in the 1970’s by two Dutch psychologists for individuals with severe disabilities (Stephenson & Carter, 2011).  MSE was originally known as the Snoezelen approach but it is now referred to as the MSE approach (Stephenson & Carter, 2011). The purpose of a MSE was to promote relaxing and calming sensations (Haggar & Hutchinson, 1991). However, today the multisensory approach is also used for therapeutic and educational purposes (Hogg, Cavet, Lambe, Smeddle, 2007).

MSEs are currently used to enhance the various sensory systems in the body (Messuber, 2012). MSEs are used with a variety range of clients including autism, brain injuries, challenging behaviors, developmental disabilities, and dementia (Messbauer, 2013).  This intervention approach has also been utilized in school-based settings for students with disabilities (Stephenson & Carter, 2011). However, MSEs can also be used as a leisure activity for individuals with or without disabilities (Haggar & Hutchinson, 1991). Despite the wide range of use of MSEs there is limited evidence-based research associated with the benefits of MSEs (Stephenson & Carter, 2011).

MSEs are used for various reasons in the healthcare field today, including education, therapeutic, and leisure purposes (Messbauer, 2013; Stephenson & Carter, 2011). However, therapists provide appropriate sensory stimulation based on the client’s specific needs (Stephenson, 2002). This intervention approach can be provided through an individual or group interaction session (Hill, Trusler, Furniss, Lancioni, 2012). MSEs are easy to implement because they do not require additional skills or training (Mckee, Harris, Rice, Silk, 2007). The primary reason for using MSEs is to address emotional, behavioral, and sensory needs of clients (Hotz et al., 2006; Martin, Gaffan, Williams, 1998; Maseda et al., 2014; Schreuder, Erp, Toet, Kallen, 2016). MSEs produce calming and relaxing sensations (Chan, Fung, Tong, Thompson, 2005; Poza, Gomez, Gutierrez, Mendoza, Hornero, 2013; Stephenson & Carter, 2011).

Additionally, MSEs can also be utilized for leisure purposes to treat neurological disabilities (Collier & Truman, 2008). This intervention approach also improves task engagement levels in older adults with disabilities (H. Kaplan, Clopton, M. Kaplan, Messbauer, McPherson, 2016).  Moreover, research indicates that this intervention approach increases functional and vocational skills in the adult population (Singh et al., 2004). MSEs can also be used to improve parent-child relationships by increasing parental involvement through play (Castelhano, Silva, Rezende, Roque, Magalhães, 2013; Nasser, Cahana, Kandel, Kessel, Merrick, 2004). This intervention approach enhances exploration and communication skills during the early childhood years (Castelhano et al., 2013; Stephenson & Carter, 2011, Suanda, Smith, Yu, 2016).

There are various benefits associated with the multisensory learning approach (Shams & Seitz, 2008).  Research suggests that multisensory interactions play an important role in everyday perceptual tasks (Shams & Seitz, 2008). Multisensory interactions increase neural plasticity and enhance our ability to learn (Shams & Seitz, 2008). Moreover, multisensory stimulation improves memory by providing redundancy and increases our ability to recognize objects when compared to uni-sensory stimulation (Shams & Seitz, 2008). Multisensory learning approaches also address the different learning styles and allows individuals to learn through a combination of senses (Shams & Seitz, 2008).

This intervention approach has been utilized to increase overall attention and task engagement levels across the lifespan (Stephenson & Carter, 2011; Kaplan et al., 2006). MSEs play an important role in increasing sustained attention among special needs students (Thompson, 2011). Thompson (2011) measured engagement levels by observing specific skills such as; facial expressions, body language, and the number of verbal cues required by a child.  Pre-and post-intervention data demonstrated changes in student engagement levels and on task behaviors (Thompson, 2011). Moreover, MSE treatment is beneficial for the adult population because it improves task engagement levels by allowing them to focus on specific functional activities such as making a sandwich or catching a ball. (Kaplan at al., 2006). Additionally, Mitchell & Gaag (2002) also state that MSE sessions increase an individual’s ability to engage and interact with their environment when compared to non MSE sessions.

Evidence based research also suggests that MSEs are beneficial in eliciting positive moods and emotions (Maseda et al., 2014). Musical activities such as songs, storytelling, and movement sessions combined with a MSE can be used to develop positive emotions in children (Lee, 2016). Musical activities develop positive emotions such as smiling and clapping and also help develop self-regulation skills (Lee, 2016). MSEs provide appropriate sensory stimulation that directly impact mood and behavior (Schreuder, 2016). MSEs induces a state of happiness and enhance emotional exploration skills in individuals with disabilities (Chan et al., 2005; Fava & Strauss, 2010).

This intervention approach also enhances cognitive and social interaction skills across the lifespan (Goswami, 2008). Research indicates that multisensory experiences consistently improve our cognition by creating fiber connections in the brain (Goswami, 2008). Infants experience enhancement of brain structures during developing stages (Goswamin, 2008). This enhancement occurs due to the environmental stimuli that is present within their surroundings (Goswami, 2008).  MSEs should be utilized in classrooms because they play an important role in multisensory learning (Goswami, 2008). A multisensory approach creates a stronger network of neurons in our brains which allows us to learn through multiple senses (Goswami, 2008). Moreover, a brain pattern study tracked neural networks in preschoolers before and after using a multisensory learning approach to recognize alphabet letters (James, 2007). The impact of a multisensory learning approach was substantial because the brain patterns activated several motor areas in the brain (Goswami, 2008). This motor activation was present because of past multisensory learning experiences with the letters and had resulted in fiber connections that combined the senses together (Goswami, 2008).

Research indicates that learning is more effective when individuals learn in groups rather than learning independently (Goswami, 2008). This group or peer interaction is beneficial during the developing stages because it enhances communication and language skills (Gosawmi, 2008). MSEs allow children to develop social skills by sharing and communicating with their peers (Hussien, 2010). Goswami (2008) also states that neurons in the brain respond to goal directed actions that are performed by individuals in the physical environment. Infants develop social interactions skills at an early age by observing and acting on such goal directed actions of others (Goswami, 2008). The zone of proximal development theory by Vgostky (1978) also states that social interactions play an important role in cognitive development (Goswami, 2008). Teachers and professionals in schools often create such environments to enhance social and cognitive skills (Goswami, 2008).

MSEs also produce motivational and relaxation sensations among students in the classroom (Stephenson & Cater, 2011). Teachers can intrinsically motivate children to participate in task engagement activities by embedding an interesting item or toy within the task materials (Deris & Carlo, 2013). Children are extremely motivated when they have the opportunity to make a choice because it allows independence and control of the activity (Deris & Carlo, 2013).  Evidence-based research also suggests that Snoezelen multisensory stimulation induces a state of relaxation even in the adult population (Poza et al., 2013).

MSEs also demonstrate calming and relaxing effects in elderly participants, but overall outcomes do not result in significant carry over effects (Martin et al., 1998). Chan et al., (2005) also suggest that MSEs significantly improve relaxation levels in clients with developmental disabilities. Chan et al., (2005) measured relaxation outcomes through different assessments such as pulse rates, behavioral relaxation scales, and Snoezelen Diary Cards.  All assessment outcomes indicated that MSEs produce relaxing sensations and positive emotions in clients (Chan et al., 2005).

MSEs have demonstrated to be effective in decreasing negative behaviors in the classroom setting (Stephenson & Carter, 2011). School teachers did report some behavioral changes after the use of MSE (Stephenson & Carter, 2011). Individual MSE interventions did result in reduction of maladaptive behaviors in the client’s daily interactions (Lotan & Gold, 2009). The frequency of behaviors was mainly evaluated by focusing specifically on concentration and responsiveness levels (Lotan &Gold, 2009). MSEs are beneficial in reducing disruptive behaviors but only in individuals with autism (Fava & Strauss, 2010).

Evidence against Capstone

The effectiveness of MSEs as a clinical intervention approach has been criticized over the past several years and there is debate about whether MSEs should even be considered as a therapeutic approach (Sevlin & McClelland, 1999). Researchers have reported many positive outcomes associated with MSEs, but there are many factors that can influence such outcomes (Mount & Cavet, 1995; Hogg et al., 2001).  Mount & Cavet, 1995, argue that factors such as increased staff members and user controlled input can influence positive outcomes associated with this intervention approach. Many studies have reported that MSEs are not beneficial in improving all types of behaviors (Chan et al., 2005; Mckee et al., 2007; Tunson &Candler, 2010).

MSEs are beneficial when such interventions are compared to non-MSE (Hogg et al., 2007). However, there are only few positive outcomes associated with MSEs without any intervention comparisons (Hogg et al., 2007). Another major concern with MSEs is that there is a lack of carryover effect (Mckee et al., 2007; Stephenson,2004). There is mixed research about the perceptions and effectiveness of this approach (Hogg et al., 2007). Nonetheless, further research would be valuable to learn more about the specific outcomes associated with this approach.

Needs Assessment

There were several reasons for conducting this needs assessment. The first reason was to address the multi-sensory needs of preschool children. It is important to address this because during their early years, children learn by exploring their surroundings. Therefore, preschoolers need a structured sensory environment that not only stimulates their senses but also teaches them new development skills such as cause and effect (Messauber, 2012). The second reason for this needs assessment was to learn more about the benefits of sensory rich environment for preschoolers. There is limited evidence based research about the effectiveness of MSEs on preschoolers. Thus, the implementation of a sensory basket would provide us with information about how sensory rich environments affect transitional, behavioral, and social skills in preschoolers.

Another reason for this needs assessment was to address the specific needs of Smart Cookies. The teacher mentioned that there were several sensory ideas that she wanted to implement in the classroom but, did not have enough resources to do so. She stated that it would be beneficial for the children to have the opportunity to explore a variety of resources that the classroom currently lacks. The last reason for the needs assessment was to address the need of MSEs in the North Country.  During my research, I found that the North Country had limited MSEs available for children (A. Cutler, personal communication, October 12, 2016). There are many barriers to providing MSEs especially in a rural community that lacks funding resources (Wallace, 2016).

Moreover, there are few schools and clinics in the North Country that provide sensory equipment for children (A. Cutler, personal communication, October 12, 2016). SUNY Potsdam has a website that provides parents with multi-sensory strategies for their children (Romeo & Maroney, n.d.). However, these are just simple strategies for parents that may or may not influence behavior and participation skills in the long run. There is limited MSE equipment in the community because of lack of funding for schools and hospitals in Potsdam (Wallace, 2016).

However, there are clinics in farther developed areas such as Syracuse, NY that provide MSE rooms (Pediatric Multisensory Environment, n.d.). Nevertheless, it is important to take into consideration that parents do not have access to MSE environments in local towns such as Potsdam and Canton, NY. This need could be addressed by educating professionals in the North Country about the use and benefits of MSEs for children.  The American Association of Multi-Sensory Environments also provides training and information for professionals who are interested in building a MSE (Messbauer, 2013).

The overall purpose of the needs assessment was to learn about the multi-sensory needs of preschool children and whether a sensory rich environment would be beneficial for them. The current feel of the Smart Cookies daycare is that they have a limited amount of multi-sensory equipment (A. Cutler, personal communication, October 12, 2016). The problem identified with the needs assessment is that a MSE is not present for these preschoolers, therefore, they cannot explore and grow in their classroom environment (A. Cutler, personal communication, October 12, 2016). The preschool teacher indicated that during transition time, there is a decrease in appropriate behavior and participation skills in some of the students (A. Cutler, personal communication, October 12, 2016).

The results of the needs assessment indicated that preschoolers would benefit from a MSE. The action plan comprised of providing the daycare center with a sensory basket. Appendix A provides additional details about the needs assessment that was conducted at Smart Cookies daycare center in Potsdam, NY.

Linking to Occupational Therapy

Jean Ayres an occupational therapist, developed the theory of sensory integration in 1960 (Smith, S., Mailloux, Z., & Erwin, B. n.d.). Jean Ayres defined sensory integration as “The neurological process that organizes sensations from one’s body and from the environment and makes it possible to use the body effectively in the environment” (Ayres,1989, p. 22). Occupational therapists are trained in adapting the environment to address such individual client needs (What Is Occupational Therapy, (n.d.).  Jean Ayres believed that the various sensory systems allow us to successfully interact with the environment (Ayres, 1972, p. 1). Moreover, additional research also suggests that a child requires appropriate levels of arousal, orientation, and attention in order to interact and engage with the environment (Case-Smith & Bryan, 1999).  MSEs certainly provide such levels of arousal and attention because MSEs allow individuals to interact with various types of stimuli. MSEs take sensory integration a step further by combining the various types of senses. Occupational therapists use MSE interventions in everyday practice to address neurological impairments across the lifespan (Singh et al., 2004; Blanche, Chang,  Gutiérrez, Gunter, 2016).

According to the American Occupational Therapy Association, occupational therapists can modify the environment to provide sensory rich input to children (Learning Through Play, n.d.). Occupational therapists can also provide structured play activities to increase participation in the classroom (Learning Through Play, n.d.). MSEs consist of various types of sensory stimulation such as colorful lights, music, and tactile boards (Martin et al, 1998).   Furthermore, occupational therapists also play an important role in increasing social participation skills (Learning Through Play, n.d.). Social interaction and behavior skills impact an individual’s ability to be successful in the future (Jones, Greenberg, & Crowley, 2015).

Hogg et al., (2007) also emphasizes the importance of studying MSEs to learn more about how it impacts social interaction skills. Thus, it is important to address social participation and behavior skills in the early years to prevent negative effects in the future (Occupational Therapy in School Settings, n.d.). Occupational therapists can address specific mental health needs of children by providing appropriate and supportive environments (Castaneda. Olson, & Cargill, n.d.). Additionally, current trends in occupational therapy focus on addressing specific client needs by providing client centered interventions to produce meaningful and functional outcomes (Maitra & Erway, 2006).

Occupational therapists also specialize in addressing transitions across the lifespan (Occupational Therapy’s Role in transitions, n.d.). Transitional services are currently an emerging niche on AOTA, especially for young adults who have graduated high school (Transitions for Older Youths, n.d.).  This emerging niche guides therapists to focus on addressing transitions in the early years to prevent difficulties in the future. Transitions can certainly be difficult for all individuals regardless of their disability status (Sterling & Jordan, 2007).

However, school teachers state that moving in between tasks is an important life skill for students (Schmit, Alper, Raschke, Ryndak, 2000). MSEs can also be beneficial during classroom transitions because they provide necessary visual and auditory cues to limit the amount of time spent on an activity (Deris & Carlo, 2013). Additionally, tangible objects can be used by the student to understand that it is time to move onto the next task (Deris & Carlo, 2013). Nonetheless, providing children with sensory input during different times of the day can increase their ability to focus on learning specific tasks (Deris & Carlo, 2013).

Occupational therapists are also trained in addressing behavioral needs that impact everyday activities (Occupational Therapy’s Distinct Value, n.d.).  MSEs demonstrate positive effects on behavior and emotional responses (Schreuder et al., 2016). Moreover, social context, personal traits, and mood of the individual also impact behavioral outcomes (Schreuder et al., 2016).  Research suggests that the physical and social environment impacts our ability to behave and feel a certain way (Schreuder et al., 2016).  Occupational therapists also use calming strategies to help children overcome behavioral challenges such as frustration and impulsivity (The Role of Occupational Therapy, n.d.).

Theoretical Model

The theoretical model associated with this capstone is the Ayres Sensory Integration theory (ASI). Jean Ayres defined sensory integration as “The neurological process that organizes sensations from one’s body and from the environment and makes it possible to use the body effectively in the environment” (Ayres,1989, p. 22). The theory states that adequate processing and integration of sensory information is an important foundation for adaptive behavior (Kramer & Hinojosa, p. 99). Moreover, this theory is associated with this capstone because it emphasizes the need for children to explore and interact with various types of stimuli.  It is necessary for preschoolers to interact and engage with a MSE to enhance their sensory systems (Scaaf & Miller, 2005). Jean Ayres developed the theory based on principles of neuroscience, biology, psychology, and education (Scaaf & Miller, 2005).

Description of project

The Smart Cookies daycare center received a sensory basket that was created at Clarkson University. A sensory basket contains numerous types of textured materials and stimuli that enhance the various sensory systems. Figure 1 provides an example of items that were included in the sensory basket for the Smart Cookies daycare center. However, it is important to note that items in a sensory basket can vary based on the specific needs of the child.  The purpose of the sensory basket was to ease transitions, increase social participation skills, and reduce negative behaviors in the classroom. The teachers can use materials from the sensory basket to create a MSE in the classroom setting.

There were a series of steps involved in creating and designing a safe and fun sensory basket. The first step to implementing this project involved collaborating with a mentor that already had some experience with the pediatric population. I consulted with my capstone mentor to discuss the various ideas that I had brainstormed for the Smart Cookies daycare center. It was beneficial to have an open discussion about the project because it allowed me to set realistic goals and helped me organize my ideas. The next step involved creating a draft waiver for the preschooler’s parents to inform them about the collaboration between Clarkson University and the Smart Cookies daycare center. The waiver ensured that we had the parent’s permission to bring items into the classroom and take pictures of the children utilizing the items. The final draft of the waiver was created by the Clarkson University faculty.

After planning details of the project, I conducted a thorough needs assessment. The purpose of the needs assessment was to learn more about the North Country and what types of sensory resources were available within the local community. The results of the needs assessment clearly demonstrated the need for MSEs in the Potsdam community. Moreover, after conducting the community needs assessment I interviewed the Smart Cookies teacher to learn more about specific classroom needs.  The interview allowed me to gather information about products that were already available in the classroom setting. The Smart Cookies daycare teacher was open to new ideas and resources that I thought were beneficial for the classroom.

However, she did emphasize the need of addressing transitions, social participation, and behaviors in the classroom. She also informed me that she wanted a portable project so that she could carry it around the classroom when it was needed. My original project involved developing a sensory corner for the daycare center. However, I realized that the teacher was interested in a portable item. Therefore, I used my problem-solving skills and created a sensory basket instead of a sensory corner.

The purpose of the interview was to learn more about the preschooler’s specific needs. Once I was done conducting the interview, I reflected on the discussion and made a list of items that would be beneficial for the classroom. I used my clinical skills to make a list of items that not only addressed specific sensory systems but were also safe to use for preschoolers. After creating the list, I met with my mentor to discuss the items that I wanted to include in the sensory basket. My mentor and I discussed specific items that would be useful and safe for children to interact with.  I made some revisions to my original list of items based on our discussion.

I wanted to gather additional feedback on the list so I shared my ideas with my professor to learn more about her perspective on the list of sensory items. Once I had a final list of items, I began to search for sensory materials that were available at a low cost and were within my budget.  The list of items that I decided to purchase for the basket included the following; body sox, bubbles, sniff and smell stickers, fidget kit, picture frames, and sit and spin. Figure 1 displays these items in detail. After conducting a thorough search, I made a list of websites to purchase the necessary sensory items. The approximate budget for the capstone project was $150 and I had to ensure that all my items were within that budget range.  I provided the information to my mentor so that she could start purchasing the items within a timely manner.

As I waited for the items to be delivered, I brainstormed additional ideas and created an outline for the tactile board. I am a visual learner, therefore, I decided to sketch out my vision of the sensory board using my imaginative skills and online resources. Once the items arrived, I used picture frames to create the sensory board with different textured materials that would stimulate tactile senses. Figure 2 displays specific textured materials that were used for each sensory frame. The different textured materials each provide various types of sensations such as soft, hard, fuzzy, bumpy, and scratchy.

I also put parts of the Sit and Spin together by using different hardware tools and assessed it thoroughly to ensure that it was safe to use.  The body sox, sniff and smell stickers, and bubbles were all prepackaged so I did not have to modify any of those items for the basket. I simply placed them into the sensory basket with all the other materials. The completed sensory basket comprised of all the sensory items I listed above.

The next step after completing the sensory basket was to create an educational sheet for the classroom teachers. My mentor and professor both advised me to create a sheet that described all the items in the sensory basket. I created a teacher education sheet to provide additional information about specific sensory systems that were being addressed through each item. I also realized that it was important to state some clinical definitions in the teacher education sheet because teachers may not be aware of some of the medical terminology. I used online resources and educational materials to describe the definitions in detail.  The teacher education sheet is available at the end of this document.

Nonetheless, once I was done with the sensory basket and teacher education sheet, I brought it over to the Smart Cookies daycare center. I provided some verbal instructions to the teacher to inform her about the details of the basket. I allowed the preschoolers to interact with the sensory basket for a few weeks. I eventually conducted an observation session where I watched the children interact and play with the materials from the sensory basket. The observation session went well and it was an exciting and fun experience. During my observation, I noticed that they started to describe the colors and textures from the sensory tactile frames. I was glad to learn that the sensory frames produced such meaningful outcomes and provided the children with the opportunity to use their cognitive skills.

During my observation, I also observed that the children were socially interacting with each other as they played with the various items. I was excited to see this happening because that was one of the outcomes associated with the sensory basket. The children were sharing the items among each other and taking turns instead of fighting for the items. They were also communicating with each other and asking questions about the various types of textures they felt. I was glad to see that the activity was bringing them all together and enhancing their social participation and cognition skills.

I also observed that after interacting with the sensory basket the children had no trouble transitioning into the next activity. The teacher provided a prompt to conclude the activity and to move onto the next task. I observed that the children did not have trouble transitioning to the next activity which was also one of the outcomes associated with this project.  I was unable to observe the impact of the sensory basket on individual behaviors because that is a long-term outcome. I believe that as the children familiarize themselves with the basket the teacher can observe whether it positively impacts behavioral skills.

The children were excited to play with all the materials and enjoyed the various sensory items. It was interesting to see that the children recognized many of the textures and smells from the sensory basket. It was a great learning experience for them because they explored all their senses during the activity. I certainly enjoyed my experience with them as well. I was glad to learn that I was addressing the children’s needs in a small but effective way. The last step comprised of gathering feedback from the Smart Cookies daycare teacher. I designed a questionnaire to learn more about her thoughts on the sensory basket. I also wanted to know if the basket improved transitional, social participation, and behavioral skills. It was important to assess these three outcomes to specifically examine the impact of my project.  have yet to gather feedback ..

Conclusion

MSEs are beneficial in increasing relaxation and calming sensations in individuals with and without disabilities (Stephenson & Carter, 2011).  This intervention approach allows individuals to successfully interact and engage with their environment (Messbauer, 2013). The Smart Cookies daycare center received a sensory basket with various types of items that addressed all the sensory systems in the body. There is mixed evidence based research associated with this intervention but many findings suggest that MSEs are beneficial in enhancing the sensory systems (Lotan &Gold, 2009). Nonetheless, MSEs should be utilized in preschool settings to develop appropriate social participation, behavioral, and transitional skills (Social skills in the classroom. n.d.).

Figure 1

Figure 2

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                                             Appendix A: Needs Assessment Chart

Problem