Is the Snoezelen method a non-pharmacological alternative for patients with neurocognitive disorders? / La méthode Snoezelen : une alternative thérapeutique chez les patients ayant des troubles cognitifs ?

Neuropsychiatric disorders are one of the frequent complications of neurocognitive disease, and have an impact on the quality of life of patients and caregivers. Non-phamacologic interventions are recommended as first-line treatment. The Snoezelen method is a multisensory stimulation method based on the assumption that acting on sensoriality can improve neuropsychiatric symptoms and thus quality of life, but its level of evidence is controversial. To explore this, we performed a systematic literature review of randomized controlled articles focusing on the use of the Snoezelen method in patients with cognitive disorders. Eighteen studies were included. The clinical outcomes studied were multiple (behavior, mood, cognition, functional capacities and biomedical parameters). When the Snoezelen method was compared to the "standard activities" group, it appears to be effective on short-term behavior. This was more negligible when the method was compared to others non-pharmacological interventions. Although the Snoezelen method could be effective on mood, cognition, and functional abilities, its level of evidence remains low. Furthers mixed studies (quantitative and qualitative) would be an interesting approach to delve into this topic in the most holistic way by integrating the patients, the caregivers and the cost of the method.

La prise en soin des symptômes neuropsychiatriques de patients ayant des troubles neurocognitifs est basée sur des traitements non médicamenteux. Certains auteurs suggèrent que la méthode Snoezelen pourrait être une alternative thérapeutique. L'objectif de cette revue de littérature était de faire une recherche systématique des essais contrôlés et randomisés ayant analysé l'effet de la méthode Snoezelen sur les patients âgés ayant des troubles cognitifs. Le processus de sélection a permis d'inclure 18 études, ayant des méthodologies hétérogènes. Dans plusieurs études, la méthode Snoezelen pourrait avoir un effet bénéfique, à court terme, sur les troubles du comportement, sur l'humeur, la cognition, ou les capacités fonctionnelles. Cependant, la méthode Snoezelen ne semblait pas être supérieure à d'autres interventions non médicamenteuses et certaines études montraient des résultats discordants. Finalement, le niveau de preuve d'efficacité de la méthode Snoezelen reste faible et des études mixtes (quantitatives et qualitatives) seraient intéressantes à mener pour évaluer l'intérêt de la méthode Snoezelen sur des profils spécifiques de patients ayant des troubles neurocognitifs.

Multisensory Stimulation and Individualized Music Sessions on Older Adults with Severe Dementia: Effects on Mood, Behavior, and Biomedical Parameters.

BACKGROUND: Multisensory stimulation and individualized music have shown to be good in handling the psychological and behavioral symptoms in people with severe dementia. OBJECTIVE: Explore the effects of two nonpharmacological interventions, multisensory stimulation environment (MSSE) in a Snoezelen room and individualized music sessions, on mood, behavior, and biomedical parameters of institutionalized elderly patients with severe dementia. METHODS: Randomized trial of 21 patients aged ≥65 years randomly assigned to two groups (MSSE and individualized music). Interventions administered in two-weekly sessions lasted 30 minutes for a period of 12 weeks. Main outcomes were recorded before, during, and at the end of the intervention. RESULTS: Both groups had immediate positive effects on mood and behavior. Participants were more happy/more content (p < 0.001), talked more spontaneously (p = 0.009), related to people better (p = 0.002), were more attentive to/focused on their environment (p < 0.001), enjoyed themselves (p = 0.003), were less bored/inactive (p = 0.004), and more relaxed/content (p = 0.003). The MSSE group performed a better visual follow-up of the stimuli (p = 0.044), and the music group were more relaxed and happy (p = 0.003). A decrease in heart rate (p = 0.013) and an increase in oxygen saturation (p = 0.011) were observed from before to after interventions in both groups, with no significant differences between them. CONCLUSIONS: Both interventions seem to be effective at managing mood and behavioral disturbances in the short term and at improving physiological rates, highlighting the efficacy of nonpharmacological treatments in patients with severe dementia.

[Therapeutic baths and relaxation in neurosurgery]. / Bains thérapeutiques et détente en neurochirurgie.

A neurosurgical nursing and nursing auxiliaries team has started using therapeutic baths. The wellbeing procured favours a re-appropriation of body awareness and a reduction in anxiety.

The Multisensory Environment (MSE) in Dementia Care: Examining Its Role and Quality From a User Perspective.

BACKGROUND: Multisensory environments (MSEs) for people with dementia have been available over 20 years but are used in an ad hoc manner using an eclectic range of equipment. Care homes have endeavored to utilize this approach but have struggled to find a design and approach that works for this setting. AIMS: Study aims were to appraise the evolving concept of MSEs from a user perspective, to study the aesthetic and functional qualities, to identify barriers to staff engagement with a sensory environment approach, and to identify design criteria to improve the potential of MSE for people with dementia. METHODS: Data were collected from 16 care homes with experience of MSE using ethnographic methods, incorporating semi-structured interviews, and observations of MSE design. Analysis was undertaken using descriptive statistics and thematic analysis. RESULTS: Observations revealed equipment that predominantly stimulated vision and touch. Thematic analysis of the semi-structured interviews revealed six themes: not knowing what to do in the room, good for people in the later stages of the disease, reduces anxiety, it's a good activity, design and setting up of the space, and including relatives and care staff. CONCLUSION: Few MSEs in care homes are designed to meet needs of people with dementia, and staff receive little training in how to facilitate sessions. As such, MSEs are often underused despite perceived benefits. Results of this study have been used to identify the design principles that have been reviewed by relevant stakeholders.

Comparing the Effects of Multisensory Stimulation and Individualized Music Sessions on Elderly People with Severe Dementia: A Randomized Controlled Trial.

The objective of this study was to compare the effects of a multisensory stimulation environment (MSSE) and individualized music sessions on agitation, emotional and cognitive status, and dementia severity in a sample of institutionalized patients with severe dementia. Twenty-two participants with a diagnosis of severe or very severe dementia were randomly assigned to two groups: MSSE and individualized music sessions. Both groups participated in two 30-min weekly sessions over 16 weeks. Outcomes were agitation (Cohen-Mansfield Agitation Inventory, CMAI), mood (Cornell Scale for Depression in Dementia, CSDD), anxiety (Rating Anxiety in Dementia, RAID), cognitive function (Severe Mini-Mental State Examination, SMMSE), and the overall severity of dementia (Bedford Alzheimer Nursing Severity Scale, BANS-S). They were assessed at baseline (pre-trial), in the middle (mid-trial), at the end of the intervention (post-trial), and 8 weeks after the intervention (follow-up). Patients in the MSSE group showed significant improvement in their RAID and BANS-S scores compared with the individualized music group post- versus pre-trial. With regard to agitation, there was improvement during the intervention in both the MSSE and individualized music groups in the CMAI total score after 16 weeks of intervention, with no significant differences between the groups. The results suggest that MSSE could have better effects on anxiety symptoms and dementia severity in comparison with individualized music sessions in elderly patients with severe dementia.

[A Swiss medical-social institution and the Snoezelen concept]. / Mise en place d'un espace Snoezelen dans un établissement médico-social en Suisse.

In collaboration with six student nurses from the Geneva Haute École de Santé, the Les Franchises medical-social institution in Geneva has launched an innovative project: the integration of the Snoezelen concept into its care programme, which will benefit residents with moderate or advanced dementia.

COMMUNI-CARE: Assessment tool for reactions and behaviours of patients with dementia in a multisensory stimulation environment.

BACKGROUND: The 'Snoezelen' is an approach based on stimulation and sensory stimulation proposals, giving priority to the notion of caretaking. The aim of this paper is to present the creation and validation of the COMMUNI-CARE scale. This is a new tool that allows for an evaluation of the psycho-emotional well-being that the patient with dementia shows in a 'Snoezelen' multisensory stimulation environment. METHODS: In total 429 evaluations in 143 multisensory stimulation interventions were made using the COMMUNI-CARE scale, in 16 patients between 53 and 85 years of age, diagnosed with moderate to severe dementia. The goal was to evaluate the psycho-emotional well-being the patients present. RESULTS: The tool's internal consistency showed a Crombach alpha of 0.90. The concurrent validity between the COMMUNI-CARE scale and the Clinical Global Impression (CGI) was of r = -0.961. The Kappa index used to determine the reliability between evaluators was of K = 0.87. CONCLUSIONS: The COMMUNI-CARE scale fulfills the basic principles of classic psychometrics of construct, and criterion validity and reliability. It does so while showing a clear idea, through its five subscales (anxiety, communication, pleasure, adaptation to the surroundings and affection), of the degree of well-being that the patient with dementia shows during such interventions. This scale embodies, through psychometrics, a very subjective human experience with a tool unavailable to date.

Multisensory stimulation on mood, behavior, and biomedical parameters in people with dementia: is it more effective than conventional one-to-one stimulation?

The purpose of this study was to assess the effects of multisensory stimulation in a multisensory stimulation environment (MSSE) such as a Snoezelen room versus one-to-one activity sessions with regard to mood, behavior, and biomedical parameters (heart rate and blood oxygen saturation). The MSSE group and activity group (one-to-one activities) of patients with dementia participated in 2 weekly individualized intervention sessions over 16 weeks, where mood and behavior before, during, and after the sessions, and biomedical parameters immediately before and after, were recorded. Immediately after the sessions, patients spoke more spontaneously, related better to others, were more attentive to their environments, more active/alert, less bored/inactive, and more relaxed/content. Both groups exhibited decreases in heart rate and increases in oxygen saturation (Spo 2) values from before to after the sessions. The MSSE sessions in a Snoezelen room were found to be as effective as activity sessions, highlighting the importance of the one-to-one interaction with the therapist.