Background
Originally devised for people with learning disabilities, the Snoezelen (derived from two Dutch words meaning “sniffing” and “drowze”) is a technic that encourages people with reduced cognitive functions to be exposed to a sensory stimulation taking place in a positive and non-stressful environment. In its most classic form, it provides stimulations to the five primary senses, through the use of lighting effects, tactile surfaces, relaxing music and essential oil.
This kind of therapy aims at promoting positive behaviours and at reducing maladaptive ones (Baker, 2001). Therefore, since the population worldwide did not stop growing in age over the past decade, its use has been extended to people with dementia. A single explanation has been provided to endorse this extension : just like people with learning difficulties, the elderly tend to have reduced cognitive functions and diminished communicative ability.
In dementia care, Snoezelen is generally employed to work in four areas (Baker, 2001 ; Spaull, 1998 ; Savage, 1996) :
- reducing maladaptive behaviours and increasing positive ones ;
- inducing positive mood and affect ;
- facilitating social interaction and communication ;
- promoting a caregiving relationship and reducing stress and anxiety.
However, whether Snoezelen is considered simply as a multi-sensory environment or as a therapeutic medium is currently in debate. Proponents of the former thought points out that Snozelen’s value is purely aesthetic and that its use as a therapy undermines this quality (Hutchinson, 1994). On the other hand, supporters of the latter thought are still exploring its benefits for individuals with cognitive impairments (Kewin, 1994). Moreover, they consider Snoezelen interventions as being inappropriate to this kind of population, since the disease’s progressive character makes them constantly insensitive and less suitable to cognitive demands and communication. However, they acknowledge that a too little sensory stimulation contributes to the decline of both these functions.
Therefore, the objective of Chung and Lai’s (2002) literature review is to examine the effectiveness of Snoezelen as a therapy for older people with dementia. Throughout a meticulous research, they finally elected two main studies, one focusing on the effects of 30-minute long sequences occuring twice a week, known as session-based (Baker, 2001, 2003), and the other on the effects of one-hour long daily sequences, known as 24-hour integrated (Van Weert, 2005). The measures conducted include behaviour, mood, cognition, physiological indices, and client-carer communication. Short-term and long-term effects on these variables were measured in both those studies.
In order to improve their findings, a control group was added in the experiments, both of which implied a standardized care during the Snoezelen sessions. Conversely, people from the experimental groups were given individual care, based on their life-story and personal preferences.
Main Results
In comparison with the control group, the session-based Snoezelen had no significant effect on behaviours, whether it is during sessions, shortly after, or on the long term. Similar findings were shown on all the other variables, save for memory, an effect that however disappeared over time.
The 24-hour integrated Snoezelen, on the other hand, provided significant effects on some specific aspects of the measured variables (as described in Baker’s (1995) INTERACT scale). Among these improved aspects are :
- enjoying self
- bored/inactive
- happier and more content
- related well (communication)
- normal-length sentence
These improvements, though, have not been verified on the long term, which led the authors to conclude that these studies revealed no evidence about Snoezelen’s efficacy on dementia.
Author’s conclusions
Precisely, why were Van Weer’s (2005) findings considered non-significant ? Although this author suggested that applying Snoezelen’s principles into daily care activities may have positive effects on behaviours, mood and interactions, she evaluated them according to the individual symptoms rather than overall performance. Also, as mentioned earlier, the benefits were only seen briefly during the sessions and were swiftly lost afterwards. This seems to have been predicted by Van Weer, who intended to establish a “Snoezelen care culture”, consisting in making the Snoezelen sequences a daily routine. This would supposedly benefit the patients on the long term, but would also be a consistent cost in time, manpower and staff training – all of which many institutions cannot provide for economical reasons.
Besides, a lack of methodological and empirical rigour was reported in both studies, mostly due to mistakes in choosing a sample size, randomization, subject recruitment, and uniform use of instruments and scales during and after the sequences.
As such, Snoezelen is nowadays employed mostly as a psychological tool in order to manage maladaptive behaviours and attempt to promote mood and communication on the very short term. As for the research field, further studies are encouraged, all to allow more empirical and rigorous results. This would imply, of course, to enhance the sample and randomization processes, and to decide on a session’s time, as the ones proposed in the two examined studies were considered too short.
Source : Chung, J.C.C., & Lai, C.K.Y. (2002). Snoezelen for dementia. Cochrane Database of Systematic Reviews, 4, 1-13.
