As OT’s, what we know about the senses and sharing this is essential right now. It needs to become everyone’s business. As OT’s, we should be using this science and the art of practice of Ayres’ Sensory Integration to help people everywhere asked to socially isolate, get the right sensory input to stay healthy and well.
Occupational Therapists everywhere should share their knowledge and skills as Covid-19 isolation ends to help ensure that people emerge from isolation as healthy as is possible from these tricky times. Many of us will have lost loved ones, and essential workers will have experienced trauma and PTSD, that will require ongoing support and therapy once this is over. However, knowing about the power of the sense to support health and wellbeing will mean that we as a profession can help maintain the health and wellbeing of people (not just children) across the globe who are having to be in social isolation right now. Many OT’s and other medical professionals have prior unhelpful beliefs, knowledge and learning about Ayres’ Sensory Integration.
“Our cognitive system has adapted to support goal-directed behaviour within a normal environment. An abnormal environment is one to which we are not optimally adapted but can accommodate through the development of coping strategies. ” Leach 2016
Long before Leach wrote this, A Jean Ayres defined the result of adequate sensory uptake and integration as being the “adaptive response”. It is not always that the challenges of getting and using sensory input come from within the person.
The environment we live in and the tasks and occupations we can engage are essential to facilitating or limiting our access to the ‘just right’ amount of sensory input to keep our minds, bodies and brains healthy and functioning.
Loss of occupation and contact with others is a significant predictor of cognitive decline in the elderly and also those who are isolated. This threat now extends to each of us.
“loneliness can wreak havoc on an individual’s physical, mental and cognitive health” Hawkley 2015
Hawkley’s suggests that perceived social isolation has adverse health consequences; depression, poor sleep, impaired executive function, cognitive decline, poor cardiovascular function and impaired immunity.
“Social isolation increases the risk of premature death from every cause for every race – Our research really shows that the magnitude of risk presented by social isolation is very similar in magnitude to that of obesity, smoking, lack of access to care and physical inactivity” Alacaraz, 2019
Taking in, making sense of and responding to sensory input from the world around is critical to human and animal survival. We know this from studies done by Harlow. The monkeys who didn’t get the right sensory input failed to thrive and develop – and some died. It is as stark as that.
Blum 2002, describes how the outcome of Harlow’s social isolation experiments in the “pits of despair” are indeed “common sense results”. Monkeys, normally sociable animals, emerge from isolation damaged – and whole some recover others are so badly affected that they do not.
Recent research tells us that neglected children who are deprived of sensory opportunities to touch and move, without trauma and abuse, fail to thrive, and are much more susceptible to illness, with delayed development of cognitive and motor skills, including executive function. Some researcher note decreased motivation to be curious and explore.
Again these are facts proved by multiple studies beyond the literature of Occupational Therapy.
“Developmental delay is often seen in children receiving inadequate or inappropriate sensory stimulation.” Ardiel and Rankin, 2010
Leach 2016 described how ‘any deviation from the optimal, particularly if personal control is lost, can result in stress. This stress can be distress or pathogenic stress if psychological and psychophysiological dysfunction occurs’.
The results of studies about sensory deprivation are often so appalling to read and share, let alone teach, that they remain hidden in journals and spoken about in the corridors of university professors.
Military research on sensory deprivation as part of prisoner torture is tough to read and often harder to access.
Yet some studies of sensory deprivation are available and reading these should make us stop in our tracks.
“This [study] provides more substantive evidence that the increase in psychosis-like experiences found in sensory deprivation reflects a genuine aberration in perceptual experience” Daniel and Mason, 2015
Hebb’s studies of Sensory Deprivation are taught on our Sensory Integration, Mental Health, Trauma and Wellbeing workshops. His researchers had hoped to observe their subjects over several weeks, but the trials were cut short because the study subjects became too distressed to carry on. Very few of the studies research subjects lasted more than two days, and no-one managed a week.
“The results were…very unsettling to us… It is one thing to hear that the Chinese are brainwashing their prisoners on the other side of the world; it is another to find, in your own laboratory, that merely taking away the usual sights, sounds, and bodily contacts from a healthy university student for a few days can shake him, right down to the base.” Hebb 1958, p 11
“Clearly man’s motivation is a function of his exteroceptive stimulation.” Hebb 1958
In the United Kingdom, Clinical Psychologist Dr Ian Robbins recreated Hebb’s experiment in collaboration with the BBC in 2008. Robbins and his team isolated six volunteers for 48 hours in a sound-proof bunker. The subjects suffered from anxiety, extreme emotions, paranoia, and all had a significant deterioration in their mental wellbeing and function. Many also hallucinated, a common feature of sensory deprivation, with subjects reporting seeing and hearing “a heap of 5,000 empty oyster shells; a snake; zebras; tiny cars; the room taking off; mosquitoes; fighter planes buzzing around”.
‘We know nothing if not through our senses’ is a rough translation from the latin, ascribed to Locke by Liebniz in the thirteenth century.
The application of the theories of A Jean Ayres and the practice of Ayres’ Sensory Integration Therapy within mental health has been a growing trend since the beginning of the century. Early work in this field started with Lorna Jean King, a colleague of A.Jean Ayres in the 1960’s, with the publication of her group-based approaches to support people with schizophrenia in the 1970s.
Ayres’ work in this field now has a growing evidence base, with the DSM diagnostic criteria for Autism finally being altered in 2015 to reflect the sensory processing and integration difficulties Ayres’ early work had identified long before.
At this point in time, many Occupational Therapists are at risk of ignoring the substantial evidence for the importance of the senses to sustaining engagement and participation in everyday life.
Industry and commerce recognise the importance of the senses to emotions and motivation, changing people’s buying behaviours through the senses; capitalising on the fact that humans intrinsically seem to know that the right sensory input keeps them healthy and well. Sensory Branding is well recognised to those trying to seek products and services; “We’re all multi-sensory beings; if brands want to engage their consumers on deeper levels, it’s time to start exploring different sensory triggers.” from SO – A boutique creative agency for luxury and aspirational brands where you can watch The Official Ralph Lauren 4D Experience – London.
‘Sensation is the only pathway the human system can use to receive information from the environment’. Smith 2002, Smith and Turner 2003
Leach 2016 describes how “Attempts are made to ameliorate the duress of living in exceptional environments by such methods as engineering the physical design, regulating temporal and photopic cycles, providing accessible communication channels to the outside world etc. Those living in these environments may also reduce the duress of their situation through developing coping skills that can serve them in either adapting to or in ignoring the environment”.
So, at this point in time, with people isolating at home, out of their usual routines and schedules, and without access to outdoor activities and meet up with others in their regular social events, the challenge is how we meet our sensory needs and remain healthy.
This is very much what occupational therapist as “lifestyle engineers” of the medical world have done in the past and now much do with vigour. Our role is to reach and help people both without and without illness and disease adapt to the strange new world we now all find ourselves living in.
We should do this so that our fellow humans can develop the skills to cope with environmental challenges and loss of activity and occupational engagement they will be experiencing when they cannot do what they might have been able to do in the past.
Learn more about this at Sensory Integration, Trauma, Health and Wellbeing.