Sensorium 4: Developing a MSE

This section will discuss the three steps of the MSE Delivery Model, beginning with the first step, to design and develop a physical space (room design and equipment selection) that is safe, comfortable, and engineered to provide consistent and constant multi sensory stimulation. The second step is about training facilitators who have an understanding of the individual’s sensory interests to provide demand-free, self-choice opportunities to empower and increase self-determination. The third step will discuss how to provide techniques for utilizing the room and equipment to facilitate change in brain arousal, behavior, and motivation.

The Physical Space

MSE utilizes visual, auditory, tactile, olfactory, gustatory, and kinesthetic (vestibular and proprioception) stimulation and sensory input to help individuals self-select the stimulation that creates pleasure and balance (Messbauer, 2006). MSE is a medium to assist in education or therapy by providing a variety of sensorimotor activities that increase arousal and/or reduce stress (Champagne & Sayer, 2003). The MSE is a medium (Pagliano, 2001) that allows for nonverbal communication through the primary senses, allowing a person to experience the process and communicate with the environment. To make this communication most effective, careful thought must be given to the room design and equipment selection.

MSE Room Design

The design must offer uninterrupted quiet, dimming of lighting, control for comfortable temperatures, good acoustics, and enough space to allow for areas of self-isolation/privacy and openness for movement by the individual. It must also have a designated control center for the operation of the MSE equipment (Messbauer, 2006). Controlling the external variables to make the room comfortable provides an open opportunity for a positive learning experience, motivation, and empowerment. Additionally, a comfortable MSE is a place to meet new challenges because the environment decreases stress levels that might be associated with meeting new demands (Messbauer, 2006).

Commonly, the room is painted white or a light neutral color (beige, cream, or pastel), which optimizes the effects of the projected light images, and provides a good contrast, as white is the absence of color and black is all colors in light. The paint should be a flat or semi-gloss to avoid undesired glare. White provides a neutral three-dimensional ground (Messbauer, 2006) where the user has the ability to create his/her own environment much like an artist starts with a blank canvas to create, thus empowering the individual. Additionally, using various projected images in motion against a white background allows for a smooth flow of uninterrupted patterns of movements (Messbauer, 2006). A white room is helpful in changing a person’s general arousal for relaxation as it is not over-stimulating.

The white room forms a giant 3D screen on which visual effects can be projected. The three-dimensional concept is important as the user is surrounded by the sensory environment. A two-dimensional concept does not provide the same effect because the user is only visualizing the environment and is limited in interactivity. While the white room has historically been used for relaxation; a white room, designed properly, can be very effective in increasing brain arousal and heightened awareness. In addition to lighting and sound effects, the white room includes soft cushions, providing tactile and vestibular experiences as well as both interactive and passive functionality (Pagliano, 1999). Small cushioned dens within the room allow children to retreat to a secure and comfortable place when being with other children may be over-stimulating (Messbauer, 2006, Pagliano, 1999).

A water area, if possible, can be very beneficial as it provides for proprioceptive stimulation. The water provides a support for the user’s body, and frees the individual to move in ways not normally possible outside the water. Moving in water is good exercise and helps the individual develop body concept, image, and awareness. Supplementary equipment such as Jacuzzi, waterfalls, lights, or fountains increase the range of stimulation and activity choices (Pagliano, 2001). Pool and Jacuzzi water temperature should be keep around 90 to 92 degrees (a few degrees below normal body temperature) in order to provide the most comfort.

Other rooms have been used for specific populations, for example: the grey room is primarily used for children with fetal alcohol syndrome and is designed to reduce stimulus. Measures are used to reduce or eliminate extraneous stimulus and help prevent the child from being distracted. Then single stimulus effects are presented within a context of minimum distraction. The dark or black room is used with UV equipment for visual stimulation. The walls, floor, and ceiling are black. On these surfaces images can be presented with maximum definition and minimum visual distractions (Pagliano, 1999).

Since space is usually limited, it is recommended that creating an MSE using a basic white room design will provide the most versatile room that can serve many different populations. This same room could contain a UV section (space permitting) where black curtains section off a small black room within the larger white room. For better auditory stimulation, acoustic tiles can be used for the ceiling and wall padding for the walls to make the room soundproof. Larger white rooms can incorporate soft play equipment, ball pools, and resonance equipment to increase vestibular and proprioceptive stimulation. A white room can be designed to maximize flexibility to accommodate a variety of individuals with and without disabilities. This is usually the best design protocol when the room needs to accommodate individuals with multiple disabilities and various populations.

While an artificially created environment provides multiple stimuli for people with disabilities, an inclusive natural area such as a verandah, garden, or playground can be changed and multi sensory features added to provide additional stimuli to individuals with disabilities. For example, the verandah can have different light effects and nature sounds that stimulate the senses. The result is a space more suitable for those with disabilities, but appeals to all. This concept is based on Universal Instructional Design (UID), which is based on the principle that learning can and should be made accessible to all students regardless of their need or learning ability to enhance the learning of every student not only those with disabilities (Battle, 2002). For example, MSE allows for better learning for children with various disabilities, but it also benefits and improves the learning of children without disabilities. Lessons in a multi sensory room for non-disabled preschoolers can be very effective in learning. UID is based on the principle of Universal Environmental Design, which improves physical spaces in the community (i.e., buildings, transportation systems, and other systems). In doing so it not only benefits people with disabilities, but also makes life easier and better for others (Battle, 2002) and promotes inclusion.

When designing a room, space requirements depend on: (a) types of populations served (various populations with disabilities or a specific population); (b) ages to be served; (c) number and function of rooms (e.g., soft play rooms, vestibular room, tactile room, auditory room, computer operated, or pool); (d) special themes and utilization of the hall spaces as part of MSE; (e) number of people to use the room at one time (e.g., an individual using the room with their caregiver or family or groups of individuals); (f) a transportation system for free movement within the room and facility (e.g., ceiling track); (g) access requirements that go beyond ADA; (h) electrical requirements; (i) space for transition. For example: changing shows, space for changing areas, and secure storage for belongings. It is also recommended to install a video system so that sessions can be recorded and observed later.

MSE Equipment

Active learning, learning by experiencing and participating in the environment, improves recall and the learning process. An active learning experience that involves touch, hearing, movement, seeing, and tasting produces better recall than any of these experiences alone. Based on this and theories and practices around sensory learning, it is important that MSE equipment promote the ability to stimulate as many of the senses as possible. It is equally important that the facilitator (teacher, parent, nurse, or caregiver) understands the importance of sensory stimulation and the sensory interests of the user.

Select equipment for your MSE that can be interfaced with various switching devices so as to be controlled by both the user and the facilitator (Messbauer, 2006). Have at least one or two pieces of equipment that are awe–inspiring, such as bubble tubes. Each MSE element or equipment is selected based on multiple layers of sensory output that influences the individual’s sensory system. Choose equipment that stimulates more than one sense. For example, bubble tubes offer visual, auditory, and tactile (particularly vibration) effects. Include a variety of instrumental music and a sound system that can play at least three different musical selections as seamlessly as possible. Make sure that the equipment provides enough choices and control to empower the individual. The equipment should have enough variety to provide all types of primary sensations to elicit and access an individual’s sensory interest and to act as motivators to the individual. Have just enough change so the person’s sensory/nervous system does not habituate for too long to the sensation. The MSE room and equipment should provide a variety of stimuli including:

  1. Light effects produced by projectors and effect wheels that disburse light patterns throughout the room, bubble columns, spotlights, star panels, fiber optics, UV lights, mirror balls, and sound activated string light and fan light.
  2. Sound effects, including pleasant music, nature sounds, interactive sound and music boards. Select rhythmic music with a variety of tone, pitch, rhythm, and spacing.
  3. Tactile experiences of changing textures on an interactive tactile wall panel or gentle vibrations and massage, fans that generate wind. Soft comfortable items to touch or hug such as a tactile column made with fur, feathers, etc.
  4. Soft items, such as thick floor mats, pillows, vibrating chairs, waterbeds, and beanbags.
  5. Sensory activities, such as blowing bubbles, drums, musical instruments, finger painting, and using play dough.
  6. Tasting experiences of different flavored drinks and foods.
  7. Motion stimulation, including soft therapy rockers, platform swings, and ball pools. Ball pools provide comfortable pressure. The effect projector can also be used to stimulate the vestibular system.
  8. If possible, hydrotherapy such as whirlpool, Jacuzzi, running water in a fountain that can be touched and interacted with.
  9. Aroma diffusers should be added with caution. Since the sense of smell goes directly to the limbic brain and is a primitive sense, it is a very powerful stimulus and can evoke very powerful responses. So unless the facilitator is sure of the likes and dislikes of the user, they should refrain from using aroma. Although an interactive aroma box, where the child is able to press a button and chose the aroma is effective and since it is self-selected and not long lasting, it is less likely to cause negative reactions.
  10. The room should have a central control center near the entrance where each piece of equipment can be controlled by a switch on the wall. The regular lights in the room should be on a dimmer switch so that transition into the room can take place through control of the intensity of the room’s lights. All equipment elements should be capable of either a passive or interactive mode using switches. Various switches allow the individual to have control over the MSE and establish an interactive approach to MSE.

Switches and an Interactive Approach

One of the most important components of an MSE is the ability for the user to control their environment. Various switches provide an interactive approach that allows for self-choice, control, and produces a cause-and-effect relationship. An interactive environment produces a feeling of achievement, enjoyment, control, and a shared experience with the facilitator. The use of switches allows the individual to control items within his or her environment, enticing the user to reach out and explore. There are numerous switching (cause) devices that allow individuals with severe/profound and multiple disabilities to turn on and off equipment.

The most advanced equipment that provides cause-and-effect relationship is the wireless Digital Sensory Technology DST system. The DST system uses cause products (switches) and effects products (the equipment) to create the cause-and-effect interaction. For example, the facilitator first chooses a DST effect (or number of effects) that are of interest, stimulating, and intriguing and gain the attention of the user, e.g., bubble tubes, fiber optics, etc. The user is able, with a touch of a single button, a breath, or sound (cause), to change the entire color and visual of the room (effect). This provides a great motivator. The technology is also sound activated. A user loves the fiber optics being laid over him or her, but does not have the motor skills to press buttons or turn the cube. The enabler quickly creates a link between the sound activator and the fiber optic light source. Now when the user makes a sound or bangs on a drum, he or she gets an instant reward as the optics change color in response to the sound.

The sound activator also reacts to the beat of music, creating a synchronizing effect (Bray, 2007). Ranges of switches include voice- and sound-activated remote sensors, touch sensors, head tilt, etc.

More on Effect Projectors

The effect projector is particularly versatile. With a variety of wheels and accessories, combined with music options the effect projector can be used for relaxation or arousal. The effect projector can also be linked to educational themes. Blank wheels can also be for children to draw on and create their own topic. Photos and slides can be printed on the wheels as well. Use of the panoramic rotator allows the facilitator to increase stimulation to the visual processing system and, as the user turns his or her head and neck to follow it around, the vestibular system is stimulated. Messbauer (2006) developed a continuum of effect wheels to affect arousal levels (see projector exercise in Appendix A).

More on Music

The structure of sound consists of tone, frequency, pitch, and intensity. Pitch is a psychological phenomenon related to the frequency of vibrating air molecules. Sound waves themselves (molecules of air vibrating at various frequencies) do not have pitch. Their motion and oscillations can be measured, but it takes a human (or animal) brain to map them to that internal quality we call pitch. We are moved by rhythm, it stirs our bodies. By almost all accounts the music of our ancestors was heavily rhythmic. Tonality and melody stir our brains and the coming together of rhythm and melody bridges our cerebellum (the motor control) and our cerebral cortex (Levitin, 2006).

Tones are critical for arousal, regulation, attention, emotion, learning, and memory. Low tones create energy, are multidirectional, and easier to transmit over high tones (500-1500HZ). High tones create less energy, are unidirectional, difficult to transmit through space, carry details, and are necessary to discriminate different sounds (Frick, Stearns, Pan, & Berger-Sweeney, 2003). Monroe’s EEG testing of individuals showed that certain sound patterns match the wave forms of the brain waves. This match is referred to as Frequency-Followed Response (FFR). When Monroe began to introduce binaural beat sound, similar wave forms in both hemispheres of the brain were produced at the same moment. This synchronization of the brain’s hemispheres is known as Hemi-Sync. Hemi-Sync frequencies facilitate the body’s process of achieving what is called a “trophotropic” state of healing. This synchronized, relaxed, and balanced state allows the body’s natural defenses and immune system to utilize a much higher percentage of its energy reserves (Morris, 2004). Preferences are very personal and based on experience and early family and/or environmental history, yet music or rhythms that help entrainment are best. Entrainment is the process of two rhythms developing the same pulse through close proximity to each other (Morris, 2004).

Drumming is becoming an important therapeutic tool. In nursing homes, listening to music with rhythmic cues improved motor coordination in stroke patients and in those with Parkinson’s disease, helped them walk up to 50% faster (Bernstein, 2004). Everything we do in life comes down to rhythm. If something is off, we can reintroduce a correct rhythm to realign our physical and emotional state. Alzheimer’s researchers report patients who are unable to speak but can sing childhood melodies, and those barely able to walk who can dance a waltz. Neuroscience has no sure explanation, but some experts think the brain’s receptors for music and rhythm are spared the early ravages of senility, thus music can improve the quality of life and offer another way for family members to communicate with their loved one.

Selecting Music

Select a category of music that supports the general goal directions for the individual (i.e., relaxed focus or increased arousal level). The relaxed-focus recordings can provide an excellent background for individuals with sensorimotor difficulties. They stimulate an open focus of attention and work well in an interactive environment. They also support sustained physical and mental relaxation. Relaxed-focus music is usually selected for individuals with high muscle tone or sensory processing problems (including those of autism and pervasive developmental disorders).

The concentration music is designed for a narrower focus of attention and a higher level of alertness. They are appropriate for many children who have poor attention skills and hyperactivity. The higher-frequency binaural beats stimulate brain-wave patterns in the high alpha and low beta ranges that are often missing in children with attention deficit disorders.

Implementation of Music

When playing music watch carefully for any cues that the music you have selected is not acceptable. Even very young or delayed children will let you know through nonverbal cues. If you sense that the music is not acceptable, don’t use it. Children may turn off the music, become irritable, cry, or tune out. If you suspect that the sound is aversive, change music. Explore several different CDs during the session, always observing the child’s response to a particular piece of music or to the binaural beats.

More on Vibroacoustics

Vibroacoustics is the process of hearing sound vibrations through the body (Boakes, 1990). This is accomplished through specially constructed chairs, treatment tables, or beds (some with water) that are equipped with powerful speakers designed to vibrate the body with optimal psychological and physical impact (Pierson, 1996). The purpose of vibroacoustics is to create tactile-soma integration. The body holds emotional events in cellular memory. The use of vibration from 8–180 Hz has the effect of disengaging those resonant patterns that seem to run in loops and fixate themselves in the body (Pierson, 1996 ). Vibroacoustics change the bio-electrical signature of the emotional imprint. Pierson (1996) emphasizes the power of bone conduction, others consider skin absorption of sound equally important. Whole-body acoustic stimulation is based on the skin as a powerful sense organ: Our skin is not just a covering; it is an enormously sensitive organ with hundreds of thousands of receptors for temperature and vibrotactile input. Every organ of perception develops ontologically and phytogenetically out of skin. In the embryo, skin folds and then forms our eyes and ears. Our skin may contain the latent capacity to perceive light and sound. Stimulating the skin with energy in the right way, you can potentially repolarize the brain and charge it with energy (Pierson, 1996).

Benefits of vibroacoustics include pain management, anxiety relief, symptom reduction, physical therapy, and health improvement. Vibroacoustics can also increase quality of life and be used to manage behavior in psychiatric settings, geriatric facilities, child life centers, and palliative care facilities (Pierson, 1996). Low-frequency sounds between 20 and 120 Hz can be used to generate vibrations for children with severe physical and mental handicaps.