Special education, rehabilitation, vocational education, and allied health are some of the fields that view disability from a medical and economic perspective. Prior to 1970, the medical and economic perspectives were dominant (Engel, 1977). The medical and economic perspectives focus on persons’ disabilities rather than on their abilities which stereotypes individuals with disabilities as second-class citizens (Boyle, 1997). Often individuals with disabilities are seen as “owning” the problem rather than having limitations caused by environmental restrictions such as discrimination (Kaplan, 2000). In the 1970s, the traditional medical and economic perspectives were challenged by the sociopolitical perspective on disability (Cook, 1987).
People with disabilities made the case that their problems stemmed from the architectural and attitudinal environment rather than from their physical, intellectual, or psychological impairments (Bogdan & Taylor, 1976, 1982).
During this period, services for individuals with disabilities underwent considerable changes (Pagliano, 2001). These developments were normalization, making the life of individuals with disabilities as normal as possible (Bank-Mikkelson, 1969); de-institutionalization, the process of moving individuals with disabilities out of institutions and into the community (Wolfensberger, 1972); and mainstreaming, the process of moving children with disabilities out of segregated special schools into regular education (Kirk & Gallagher, 1989). The sociopolitical perspective encourages people with disabilities to interact with their environment (Kirk & Gallagher, 1989)
Disability is a social construct, and the United Nations definition of disability states, “Society creates a handicap when it fails to accommodate the diversity of all its members” and that attitudinal and environmental barriers prevent “full, equal and active participation in society” (cited in Preistly, 2001b, paras 3 and 4). Yet, persons with intellectual disabilities (ID) are frequently the most vulnerable group and, on many occasions, are exposed to human rights violations and deprived of minimum services and dignity. These persons are also the most likely to be secluded, unable to access basic health and educational services, and excluded from ordinary social relations (The World Health Organization, 2004; Leonard & Wen, 2002).
Yet individuals with disabilities offer us valuable lesson in life. Individuals with disabilities help the able bodied more than the able-bodied every help them, because this individuals remind us of our greatest assets, our weakness, and humanness (Vanier, 2002). Individuals with disabilities do the work of the heart (Vanier, 2002).
Essential services and educational tools are needed to improve education and the quality of life of individuals with ID. Systematically developing methods of reinforcement for persons with severe and profound intellectual challenges can help professionals to identify sufficient numbers of positive stimuli. One solution is Multi Sensory Enrichment ™ (MSE). Multi Sensory Enrichment ™ provides alternative resources for staff, child life professionals and educators to work purposefully and effectively with people with severe and profound developmental disabilities, autism, mental retardation, dementia, and other disabilities (Haggar & Hutchinson, 1991; Mount & Cavet, 1995; Stephenson, 2002; Thompson & Martin, 1994; Williams, 2001).
Multi sensory stimulation is important because we live our lives through our senses and benefits persons with and without disabilities. Sensory organs are referred to as the window to the brain. The maturation of one’s nervous system continues to develop during the first six years of life and is dependent upon the successful stimulation of the nervous system via sensory organs. The constant stream of data obtained through our senses helps the brain to interpret our surroundings, giving us vital tools to survive and thrive. On daily and moment by moment basis, multi sensory experiences affect our motivation, attitudes, emotions, learning, physical activities, and our very being (Lotan & Shapiro, 2005). It is through our senses that we learn and develop an understanding of our environment (Ayres, 1979, 1982). Any form of disturbance that disrupts a person’s interaction with the environment may impede development and/or enjoyment of life (Lotan & Shapiro, 2005; Stephenson, 2002).
People with limitations of movement, vision, hearing, cognitive ability, constrained space, behavioral and comprehension difficulties, perception issues, or pain never experience interactions with their environment and are limited to the sensory input that we take for granted. It is difficult for these individuals to create their own optimal environment or sensory experience as their world is often narrow, confined (Messbauer, 2006), and in most cases controlled for them. For example, the average person touches 300 surfaces every 30 minutes. We barely perceive the extraordinary amount of stimulation bombarding our every pore, yet we rarely consider how many surfaces a person who is wheelchair-bound touches in the same timeframe, as well as the consequences of such limitation (Messbauer, 2006). This kind of example can be played out for each of our senses and for every opportunity that we enjoy; such opportunities are often unavailable physically and/or cognitively to individuals with severe and profound disabilities. This limited sensory awareness and stimulation not only affects children’s learning abilities, but also disadvantages their quality of life (Hogg, Cavet, Lambe, & Smeddle, 2001; Lancioni, Cuvo, & O’Reilly, 2002; Stephenson, 2002). It is interesting to note that the U.S. Government in 2008 deemed that limiting sensory experience for prisoners of Guantanamo Bay as a form of torture. Yet, this same government has failed to provide stimulating environments and sensory stimulation to individuals with profound disabilities who are unable to access sensory stimulation on their own.
When cognitive abilities are impaired either through brain injury, mental retardation, developmental disabilities or dementia; stimulation is often the only means to keep these individuals active, happy and healthy. The level of function achieved by an individual is a reflection of the stimulation and opportunities afforded the individual by his or her environment. When the environment offers nothing the individual fails to thrive. “Failure to thrive” syndrome is a condition in which an individual has lost the will to live and often enters a state of withdrawal. Studies have shown that young children, individuals with disabilities, and elderly persons are especially vulnerable to the failure to thrive. Furthermore, brain injury and poor maturation of the nervous system disrupts the brain’s ability to receive, process, store, and utilize information, leading to neurological dysorganization. The ability to stimulate a dysorganized or cognitive impaired neurological system is reflected in the child’s growth and development, or lack of such. An individual is either learning or forgetting and if they are being stimulated they are learning. Cognitive impaired individuals need to develop personal strengths and find alternative ways to learn and adapt. It is important for these individual to be provide this opportunity throughout a lifetime.
Forceful legislation provides individuals with disabilities a multitude of special rights, however there are shortfalls in the legislation that allow individuals with disabilities equality in life, leisure time, recreation, and community involvement. The leisure time of individuals with disabilities is frequently isolated and while their handicap is one obstacle, the most important obstacle is the lack of human and social support. Despite the evidence that providing sensory (tactile, auditory, visual, olfactory and kinetic) stimulation improves health and enhances quality of life, few facilities exist that are accessible to the public and open individuals with disabilities
Purpose
MSE has been shown to increase individuals’ awareness, environmental exploration, mental and physical relaxation, enjoyment, social skills, choices, and feeling of restoration and refreshment (Long & Haig, 1992). However, empirical research around the concept of MSE is very limited, and the use of MSE in special education or as an activity for individuals with disabilities is minimal. Most research around MSE today has been based on subjective observation of participant behaviors and generally has not been operationally defined or objectively measured (Pagliano, 1999). Additionally, as of 2008, MSE is available in every school and rehabilitation center throughout Europe, yet there are less than 100 in the United States.
Reasons for this insufficient empirical research and lack of use of MSEs in the United States range from a limited perception that research is necessary to a disagreement regarding what should be researched (Pagliano, 1999). Research and formal evaluations of MSE meet resistance because they are feared to force individuals with disabilities into more structured, outcome oriented therapy, in contrast to freely chosen recreation (Glen, Cunningham, & Shorrock, 1996). Unfortunately, all too often activities for those with disabilities have to be justified on therapeutic grounds, although no one disputes the importance of play and self-selected activities for normally developing children (Glen et al., 1996). Hutchinson and Haggar (1991) argued against conducting outcome orientated research, stating “it is hoped that future workers in the field will not feel obligated to justify the existence of MSE purely in terms of therapeutic outcome …. Do we justify our own leisure pursuits in term of their therapeutic value?” (p. 34).
Yet, given the observed and qualitative benefits of MSE as a leisure activity and an educational tool, empirical research would strength the argument of the benefits as well add to the body of knowledge in complementary theories, such as neuroplasticity (Giza et al., 2005; Hotz et al., 2006) and life quality (Hulsegge & Verheul, 1987).
There is a need to develop clear theoretical basis for the use of MSE, answering questions as to: (a) Why does MSE appear to be so beneficial to individuals with ID? (b) Can MSE be used as an educational tool? (c) Is MSE more effective as a controlled therapy or a voluntary recreational activity? (c) what effect does the facilitator have on the outcome when using a MSE? (d) Is a passive or interactive approach to MSE more effective? (e) Does a natural MSE environment work just as well as an artificially created MSE?
The purpose of this course is to identify new developments, converging themes, and emerging controversial issues around MSE and teach a MSE delivery model that enhance the life, happiness, health and social well-being of children and adults with disabilities.
This course begins with an overview of MSE, including definition, history, and benefits followed by an overview of neuroanatomy. New developments in neurophysiology and neuro plasticity are discussed. Converging themes around MSE, learning, development, and brain arousal are presented. Controversial issues in MSE are identified. All this evolves into the development of a theoretical basis leading to the development of a delivery model for MSE. The paper ends with the discussion of areas for future research.