April 17, 2005

A mother and son in the ‘Snoezelin’ room at Beit Issie Shapiro in Ra’anana.It’s a long road from the Netherlands to Israel to Miami, but that’s the path that a novel therapy used to treat children with special needs has followed – with sparking results.

Israeli therapist Michele Shapiro has played a leading role in the introduction of Controlled Multi-Sensory Intervention (CMSI) therapy using the Snoezelen method to the University of Miami/Jackson Memorial Medical Center.

Snoezelen (from the Dutch ‘to doze’ and ‘to sniff’) is the original and most commonly used tool for the application of CMSI.

The concept of Snoezelen was defined in the late 1970’s by two Dutch therapists, Jan Hulsegge and Ad Verheul. While working at the De Hartenberg Institute in Holland, a center for people with cognitive disabilities, the two therapists learned of the positive responses a colleague was able to elicit from his severely challenged clients when they were exposed to a sensory environment he had assembled. The environment stimulates the primary senses of sight, hearing, touch, taste and smell, through the use of lighting effects, tactile surfaces, meditative music and the odor of relaxing essential oils.

Beit Issie Shapiro, a Ra’anana-based community organization providing a range of services for children with developmental disabilities and their families, introduced the therapy to Israel, and has played an important part in the establishment of each of the approximately 160 CMSI units that now operate in the country.

“I feel that the Snoezelen is like an alarm clock. It gets the person awake, aroused, brought to a good readiness level, and accessible to other treatments,” Shapiro told ISRAEL21c.

Shapiro and her staff trained most of the hundreds of therapists, social workers and doctors involved in administering the therapy. It was that expertise that led her to the U. of Miami Medical Center in January 2004, when she was invited with a colleague to demonstrate the use of a newly acquired Snoezelen room to the staff of the neurotrauma unit of the center.

“When I asked colleagues who I should use to introduce the technique, they all pointed to Michele,” Dr. Gillian Hotz, Co-Director of the hospital’s Pediatric Neurotrauma Program told ISRAEL21c. “Beit Issie has had outstanding results from the application of CMSI, and Michele is an experienced lecturer. Who else can claim to have trained nearly a thousand people in the use of the method?”

CMSI is applied to treat a wide range of mental and developmental disabilities. It requires a means of controlling the environment, such as the Snoezelen, and an ‘enabling therapist’. Control of the amount, intensity, and nature of sensory stimuli, reduces the client?s tensions and makes it easier to communicate with and influence him.

The Snoezelen provides a bland, soothing environment onto which various types of stimuli can be imposed. When the client – whether a child with special needs or an adult who is suffering from brain injury, stroke, or dementia – enters the Snoezelen he finds himself in a space whose floor is covered with large off-white mattresses, and whose walls and ceiling are upholstered with soft off-white padding. He makes himself comfortable and, together with the accompanying therapist, relaxes in the low lighting and the soft regular music.

After a time, the therapist sets a nearby object rotating or vibrating, releases an aroma, or lights up one of the many optical displays in the room; there are illuminated columns of liquid through which bubbles of various sizes rise; a Catherine wheel-like display of lights; skeins of multi-colored optical fibers; and reflecting mirror balls.

A CMSI room can be used in two ways. The first gives clients temporary relief from their disabilities: the hyperactive are calmed by elimination of stimuli to which they are hypersensitive, the passive and non-communicative find a channel though the wall that separates them from the rest of the world. The second uses the room as a diagnostic and therapeutic tool. The enabling approach to therapy mirrors the calming effect of the Snoezelen. Instead of applying a pre-planned program, which the client might find stressful, the therapist responds to the client’s lead and preferences.

In her definitive book on the subject, Snoezeling, Shapiro describes Assaf, a five-year-old with severe developmental delay.

“He was markedly passive, and showed no interest in anything. During our first sessions in the room, he did nothing. He just stared at the wall. I decided to let him be. I just sat and watched him.”

She did not intervene even when, during his third treatment, Assaf started tearing at his clothes and emitting loud sounds of distress.

“Gradually, it occurred to me that his behavior was not random. He was trying to attract my attention. He kept pulling me – he was guiding me in the direction of a tall vibrating bubble unit. When we drew near to it, I was surprised to see Assaf extend his arm and touch it. It was incredible. I’d never before seen Assaf reach out to anything. Holding him tight I told him I was happy he wanted to touch the bubbles,” writes Shapiro.

In the following weeks, Assaf became increasingly aware of his surroundings and keen to explore them. “He remains severely retarded, but the quality of his life has improved immeasurably.”

Snoezeling also tells the story of a boy with visual perception problems. Lior hated going out into the sun. In class, he cried inconsolably unless the lights were turned off and movement in the class reduced to a minimum. He sat with his head downward, never smiled, and showed no interest in his surroundings.

“At first, Lior entered the darkened Snoezelen with the only sensory stimuli being music and the faint aroma of lavender. Gradually we introduced Lior to a variety of touch stimuli such as vibration and massage. When he accepted these sensations, we introduced new pieces of visual stimuli. From the moment we started to utilize colored lights, Lior began to show an interest in his surroundings. Unlike his behavior in his classroom, he now lifted his head and looked around. He smiled, verbalized, and reached out to touch the equipment. Over the months, Lior learned to manipulate simple switches – to enjoy controlling the lights – he was in control of the amount of stimulation he received.”

Lior’s parents are now looking for a way to incorporate the helpful features of the Snoezelen into his room in their home.

Shapiro is working with the U. of Miami Medical Center to insure that the same therapy results are achieved there. The course for the staff of the neurotrauma unit of the University’s hospital was only the beginning of her involvement with CMSI in Miami. In June 2004, Shapiro presented an introductory course to at the Mailman Institute for Child Development of the University of Miami’s Department of Pediatrics, and an advanced course at the Miami Cerebral Palsy Center.

Today, she continues to advise the staff at the University of Miami/Jackson Memorial Medical Center, and will be leading a series of advanced courses later this year. Most significant, she and her Miami colleague Hotz agree on the need for standardized, systematic training for those who make use of the over 300 controlled-sensory rooms in the United States. There can be little doubt that, when a suitable training curriculum is introduced, it will bear the stamp of Israel’s Beit Issie Shapiro.

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