When carrying out assessments it is important to spend time planning prior to the MSE session. An assessment protocol should be established in order to know what skills to look for. This protocol should provide for a systematic and consistent approach. Good observational skills are important when carrying out assessments. When an MSE team or facilitator begins to work with an individual they begin to collect information about that individual. This information can be used to build on what was provided during the parent/caregivers interview as well as assessment/observation. After each session, mood and behavior should be noted, with reference to each type of stimulation used. This allows a more detailed picture of sensory awareness to develop and to inform staff of procedures employed during previous sessions (Pinkney, 1997). Reflection is an important component of the session, allowing the member of staff facilitating it to consider what went well, what did not go so well, and what could be done differently next time (see Appendix D for an evaluation guide).
First, one should gather information to establish a baseline. The facilitator should focus on identifying the child’s abilities and other information used to inform MSE design and program development. Various assessments can be used to establish a baseline as well as discussions with family members and teachers and observation of the child’s behavior. It is important to avoid listing the child’s deficits because such information does not positively inform program development nor does it help in MSE design (Pagliano, 2001). A baseline is used to determine the existing skills, strengths, and needs of the person that can be reinforced and developed through individually tailored objectives. Second, set objectives that encompass and promote the person’s strengths and needs. Third, determine the suitable equipment for the individual. And finally, monitor and assess the level of engagement and various constructs such as enjoyment factors, indices of happiness, behavioral modification, etc. Record reactions to the sessions.
Monitoring is an important aspect of the assessment process and is different from the assessment itself. While the assessment is ongoing, the facilitator (assessor) will need to monitor the frequency and duration of sessions, the variety of stimuli offered, and the information gathered to date. As part of the process, the assessor must make time in which to monitor and update the systems in use.
Time to reflect with the staff team is essential. It may be necessary to rethink the strategy, if the assessment session did not go as planned. The individual person may have shaped the session differently or there may have been barriers detracting from the main objectives. As the assessment progresses, it may be appropriate to focus on more detail in order to refine the information gathered. An example of an assessment form for recording and monitoring can be found in Appendix D
Directions for Future Research
The concept of MSE appears relatively recently in the literature. Because of its infancy, there is a lack of empirical information about the positive effects MSE has on education, recreation, and therapy. Because of this lack of information, opportunities for growth, development, and change that could essentially affect the quality of life of individuals with disabilities are missed (Pagliano, 1995). Thus, developing theory around MSE requires testing and future research.
Furthermore, educators are charged by the No Child Left Behind Act of 2001 (P. L. 107-110) to employ scientifically based research to determine teaching methods used in schools. Scientifically based research uses empirical methods, rigorous and adequate data analyses, measurements, and observations; provides reliable and valid data; utilizes an experimental or quasi-experimental design; allows for replication; and is peer-reviewed (National Research Council, 2002). To maximize the understanding and use of MSE, future research is needed in MSE and education, MSE as a recreational activity, and MSE in treatment.
The outcome of future research will lead to an effective service delivery model of MSE and provide a framework for the generalization of MSE methods, procedures, and strategies, thereby improving learning outcomes and quality of life for children and adults with severe and profound cognitive challenges.
Future Direction of MSE in Special Education
Education of individuals with multiple, severe, and profound intellectual disabilities is one of the most challenging activities in the field of behavioral analysis and special education. To teach individuals with severe disabilities, professionals must select powerful reinforcers, which are often difficult to determine because of deficits in language and lack of exposure to a broad range of potentially reinforcing stimuli (Matson, Bamburg, & Smalls, 2004).
Future research needs to examine the effects of MSE on improving the learning abilities and functionality of children with severe cognitive disabilities and to evaluate the effectiveness of MSEs as an approach to providing an optimal means of educating children with profound and multiple disabilities. Specifically, this research can determine whether exposure to a MSE assists children with severe disabilities in achieving functional skills and assess whether achievements generalize to other settings (e.g., outside environments). For example, one purpose of a study could be to examine the effects of MSE on improving the learning abilities and functionality of children with severe cognitive disabilities. More specifically, the study could seek to: (a) determine whether exposure to an MSE assists children with severe disability in achieving functional skills measured by the Functional Performance Record; and (b) assess whether achievements generalize to other settings (e.g., outside environments). Studies need to be conducted that examine and investigate the affects of MSE on physiological, cognitive, and behavioral changes in children with neurological (intellectual) disabilities.
Future Research around Multi Sensory Enriched Environments and Neuroplasticity
Because environmental enrichment typically exposes individuals to a combination of physical, cognitive, and social stimulation, it is difficult to determine how each type of stimulation contributes to its beneficial effects. Studies around brain plasticity have demonstrated that although cognitive and physical (exercise) stimulation alone can be sufficient to enhance memory, a complex enriched environment that includes physical, cognitive, and social stimuli offers most robust and widespread benefits and outcomes in children and adults with intellectual disabilities. The complex enrichment initiated at any age can significantly improve cognitive function and quality of life (Harburger, Nzerem, & Frick, 2007). Ninety percent of neurological development takes place in the first year of life. MSE helps parents and professionals make the most of opportunities to help the brain change. Future research is needed around the effects of MSE on cognition and neuro / brain plasticity.
Future Research around MSE and Quality of Life
Human rights are indivisible, universal, interdependent, and interconnected. The right to the highest possible level of physical and mental health and well-being is interconnected with other civil, political, economic, social, and cultural rights and fundamental freedoms. For persons with disabilities, as for other persons, to exercise the right to health requires full social inclusion, adequate standard of living, access to inclusive education, access to work justly compensated, and access to community services (World Health Organization, 2004).
MSE assists in achieving greater health and enhanced quality of life. A study purpose might be to investigate the effects of MSE on indices of happiness of persons with severe/profound intellectual and multiple disabilities. Happiness can be assessed using parent/caregiver ratings and the Happiness and Satisfaction subscale from the Piers-Harris Children’s Self-Concept Scale, Second Edition (Piers & Herzberg, 2002).
Future Research Regarding the Benefits of MSE as a Recreation Activity
It is believed that MSE will yield the same positive result whether delivered as a therapy or as a recreation activity, thus confirming the value of a less expensive recreation venue to improve the quality of life of individuals with severe and profound disabilities. Furthermore, if this is the case, any caregiver, educator, or parent, can be instrumental in improving the lives of these individuals through the use of MSE. A main null hypothesis put forth is that there is no difference whether MSE is implemented as a leisure activity or a therapy.