Engaging dementia patients using all the senses

WALTER ADAMS SITS in a dimly lit room. A pillow in his chair quietly vibrates. The 76-year-old man stares intently at a blue panel with rivulets of sand dripping down it in soothing cascades.

A glowing globe behind the panel changes from red to blue to green.

"There's weather moving in," the former pilot tells Robert Voogt, CEO and creator of The Memory Center, a residential center in Virginia Beach for people with dementia.

"As a pilot, that concerns you," Voogt responds.

Adams nods but doesn't take his eyes off the screen.

There's a lot about Adams and the other residents here that Voogt understands.

He knows, for instance, that Adams was a pilot during World War II, and later flew for a commercial airline. Voogt knows another resident, a former professional musician, will at some point be drawn to a piano tucked into a different corner in the facility to play Cole Porter's "Night and Day." Each resident craves something a little different, Voogt knows. Some want to chat and sing with others. Some want to be alone.

There's also a lot Voogt doesn't know, and he's quick to admit it.

He doesn't know if Adams imagines he's in the pilot's seat again when he stares into the blue panel. Or why 80-year-old Bill Mitchell remembers the notes of songs, but not the names of the musicians he played with for decades. He doesn't know if the people in the hallway working their fingers through pots of cool earth as they plant flowers will stay more engaged in the world than those who aren't.

But he knows these experiences seem to calm them and connect them to the present.

At least for a moment.

"The weather never moved in," Voogt says to Adams.

"It's going to," Adams says.

Voogt opened The Memory Center on Old Donation Parkway last fall and is using every sense he can to engage the residents, whether through smell or taste or sight or sound or touch, in an approach called Snoezelen.

The concept was developed in the 1970s by Holland psychologist Ad Verheul, who worked in a facility for people with mental disabilities. He studied how they responded to smells, music, touch and taste.

He found that overstimulating the senses of patients who had a hard time communicating seemed to relax them and help them engage with their environment.

He and a colleague, music teacher Jan Hulsegge, coined the term Snoezelen, a combination of the Dutch words, "snuffelen," which means to seek out, and "doezelen," to relax.

Snoezelen rooms and techniques have multiplied since then, most commonly in programs for people with brain injuries and mental disabilities like autism and dementia.

One of the more recent examples can be found in a corner of a room at St. Mary's Home for Disabled Children in Norfolk. The children who live here have severe physical or mental disabilities, some from trauma during birth or genetic conditions, some from abuse suffered as babies. The facility doesn't release the last names of children or their specific conditions.

Nicole Hoskins Jones, director of recreation therapy, pulls 2-year-old Jahmari out of his wheelchair and rests him on a vibrating pillow on the floor. She holds a bundle of optic lights in long, plastic tubes before his eyes.

Blue, yellow, green, red lights bob before Jahmari, and soon he is reaching out to grab them, tracking the lights with his eyes and making crooning noises.

In the corner, soothing ebb-and-flow tones of the ocean come from a sound machine. Jones can change the settings, from a rain forest with chirping birds and dripping water to a heartbeat thumping to a fountain trickling. She also has small bottles of scents, and waves one that smells like lavender beneath Jahmari's nose.

The facility set up the multisensory corner in January using grant money. Right now, preschool children use it a couple of times a week, and older youngsters in the facility love to come in as well.

Jahmari can't speak, but Jones can tell when the sights and sounds have worked: The muscles in his legs, prone to tightening when he's agitated, loosen. He makes happy crooning noises. He looks her in the eye and reaches out to grab the lights.

"You can tell he's in a different state; he's definitely more relaxed."

The Memory Center uses some of the same elements, not gathered in any one room, but scattered throughout the facility.

There's a spray of fiber-optic lights in one room, a column with slow-moving bubbles in another, some rubber balls in different colors and textures that residents can massage in their hands.

There are also sensory elements that are geared toward the older population, scenes and experiences Voogt hopes will trigger memories: A room set up like an old-time general store with shelves of Campbell soup cans and jars of canned vegetables and fruits. A town square with a replica of the Cape Henry lighthouse. A tavern where they can order a beer. A movie theater. Trails in the backyard of the facility with areas where residents can stop and put their feet in the sand. A computer with photographs of residents in their youth.

Voogt has a doctorate in rehabilitation counseling and also has built residential centers for people with brain injuries in Virginia Beach and in Louisiana.

His theory, whether the residents are brain injured or suffering from dementia, is to find what appeals to them, what makes them connect to others.

"They don't want to be warehoused - they want movement and activity, engagement," he says. "Atmosphere and environment have a lot to do with people's attitude. This is different from putting them in a concrete block building."

The multisensory method turns a key with someone at the other end of the age spectrum, 4-year-old Zachery Zimmerman, at a nearby center for autistic children.

He sits in the middle of a blue wading pool filled with raw rice at a monthly social event sponsored by Families of Autistic Children in Tidewater.

He takes handfuls of the rice and rubs them up and down his arms, across his stomach, along his legs. Then he shakes the rice off before dipping his blond head into a pile of it.

He makes noises - "Aii, aiiiiii" - as he moves his arms up and under the rice again and again, running rice down his neck and shoulders.

Zachery has autism, a developmental disorder that impairs his social and communication skills.

When he first came to the monthly socials here in a building off First Colonial Road in Virginia Beach, he'd stand outside the door and scream. His father, Billy Zimmerman, kept bringing his son back until he gradually ventured in.

The vats filled with rice and beans drew him back. There's also a table with mounds of green foam that he can use to make mountains or scoop up and ooze between his fingers.

Pam Clendenen, executive director of FACT, said multisensory approaches work well with autistic children, who have a hard time filtering sensory input. Some take in too much, others too little, either of which can lead to agitation or shutting down.

One child may need more sensory input to feel relaxed, such as being held very tightly. Weighted vests help them feel more aware of themselves instead of like they're floating in space. The organization also has a stretchy fabric the children can wrap themselves in that helps them feel the deep pressure against their skin that they crave.

The hardness of the rice and beans falls into the same category. For some, noise can help ground them, so they make yelping or crooning noises. Other children, though, find noise and light irritating. A tent set up in a softly lit room is more appealing to them.

"Some like something sticky or gooey, some reject it," Clendenen said. "Some like something rough, some don't. Some will like something in the morning, but in the afternoon, tolerate it less."

Zachery's father said his son gravitates to the hard, rough feel of rice against his skin. He likes the beans, too.

"I think it calms him, I really do."

Voogt's belief is that when people aren't able to tell you what they think or feel or want, when synapses in their brains are misfiring or not firing enough, that's not the time to give up on them.

His idea is to find more ways in, even if it's different for each person, or changes from hour to hour. Even if it's trial and error, part science, part speculation.

"I'm trying to reach into their minds. I want to make their lives rich again," he says about the residents at The Memory Center.

He often drops by the library and stands to the side, watching Adams gaze into the blue panel.

"I know he's in there."

Elizabeth Simpson, (757) 446-2635, elizabeth.simpson@pilotonline.com